Constancy and patience. This is what you need to be able to effectively treat atopic dermatitis through therapies that restore the skin to its own balance. Today, thanks to advances in scientific research, this chronic inflammatory skin disease – highly debilitating as it causes sleep disturbances, anxiety, depression and a sense of isolation – can be kept under control.
Anti-inflammatory therapies
During the acute phases of the disease, treatment is based on topical anti-inflammatories, such as corticosteroids and calcineurin inhibitors. Topical corticosteroids (or glucocorticoids) are the first choice drugs and are applied directly to the skin in relation to the symptoms (first of all itching), but it is important to use them under medical supervision and only during exacerbations because they can have even serious adverse effects . As the itching subsides, the dose, frequency, or strength of corticosteroid treatment is gradually reduced. Calcineurin inhibitors are also anti-inflammatory drugs, used in the acute phase as a second step to corticosteroids. They are particularly suitable for areas where the skin is thinner or more visible, such as those of the face. They can prevent flare-ups when used as a proactive therapy, but those who use them must protect themselves from sunlight.
The biological drug
In some cases, the doctor may consider systemic treatment including oral corticosteroids (which can be used for short periods), cyclosporine, azathioprine or methotrexate. Among the most effective drugs is dupilumab, a biologic drug approved for moderate-to-severe atopic dermatitis in adults. It is a fully human monoclonal antibody that inhibits the hyperactivity of interleukins 4 and 13 which are two key proteins in type 2 inflammation and play a fundamental role in atopic dermatitis, asthma, chronic rhinosinusitis with nasal polyposis and in ‘eosinophilic esophagitis, diseases related to each other by a common inflammatory mechanism. These pathologies can also occur simultaneously in the same person. Dupilumab is the only biological drug approved in the European Union for children aged six years and above with severe atopic dermatitis. It is currently reimbursed in Italy for adolescents and adults with moderate to severe atopic dermatitis who are candidates for systemic therapy. For adolescents (12-17 years) it represents the only systemic drug currently indicated in the treatment of moderate-severe atopic dermatitis. Dupilumab is included in the list of drugs that have obtained the recognition of innovation from the Italian Medicines Agency. It is not an immunosuppressive drug and does not require routine laboratory monitoring.
Data up to three years
Dupilumab monoclonal antibody has been studied in over 10,000 patients in 50 clinical trials for various chronic diseases with type 2 inflammation. This is also the first and only systemic treatment available to date to boast a long-term phase 3 clinical trial. , i.e. up to 3 years of treatment in daily practice, in adult patients. In fact, the phase 3 results of the Ole study recently arrived, which evaluated the long-term safety of dupilumab administered weekly in adult patients. The data showed that the safety profile of the drug in adults with moderate to severe atopic dermatitis treated with dupilumab and observed for up to three years was generally consistent with that observed in the controlled phase 3 studies.