Key words
Atopic dermatitis; cost-effectiveness; dupilumab; EASI; SCORAD

Introduction

Atopic dermatitis (AD) is a chronic inflammatory and relapsing disease characterised by dry and scale skin, eczematous lesions and intense itching that might turn chronic. AD displays a highly complex pathophysiology and heterogeneous phenotypes, which are illustrated by different features such as age of disease onset, variable response to triggers, spectrum of severity, barrier defect, potential of IgE autoreactivity and comorbidities (asthma, rhinitis, food allergy and infections) (1,2,3,4,5,6). Similar to asthma, AD research is developing and shaping precision medicine approaches aiming towards a biomarker based molecular taxonomy (7,8,9,10).
IL-4 and IL-13 are key cytokines in driving the initiation and chronicity of type 2 (T2) inflammation, a dominant inflammatory pathway in AD (11,12). Dupilumab is a fully human anti-IL-4 receptor α (IL-4Rα) monoclonal antibody that blocks both IL-4- and IL-13-mediated signalling pathways (13,14). The European Medical Agency (EMA) recommends dupilumab for moderate-to-severe AD in adult and adolescents (12 years and older) patients who are candidates for systemic therapy (15). The United States Food and Drug Administration (FDA) recommends dupilumab for patients aged 6 years and older with moderate-to-severe AD whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable (16).
The European Academy of Allergy and Clinical Immunology (EAACI) is developing clinical practice guidelines for the use of biologicals in patients with uncontrolled moderate-to-severe AD. To inform key clinical recommendations, a systematic review (SR) evaluated the effectiveness and safety of dupilumab for patients with uncontrolled moderate-to-severe AD.

Methods

Guidelines Development Group

The EAACI Atopic dermatitis Voting Panel and Steering Committee included clinicians and researchers with different backgrounds (the complete list of experts is available from the EAACI website) who voluntarily participate in the development of the EAACI biologicals guideline. They are referred to as the Guidelines Development Group (GDG).