Two medical associations raised awareness of these treatments on World Atopic Eczema Day, 14 September 2021. The drugs were even integrated into the current atopic dermatitis guidelines in 2020, which for drugs is an honour akin to knighthood.
Who is affected?
About 3.5 million people in Germany suffer from atopic dermatitis, especially children. It is estimated that half of the children and around 200,000 adults with the disorder suffer from moderate to severe atopic dermatitis. “The symptoms can greatly reduce the quality of life of those who suffer from it. At night, itching and pain can disrupt sleep. What’s more, the visible skin changes are sometimes perceived by others as ‘repulsive’, which can lead to stigmatisation”, said Ralph von Kiedrowski, President of the Professional Association of German Dermatologists (BVDD).
For many years, physicians have been prescribing drugs that suppress the immune system in adults with severe atopic dermatitis. These drugs mitigate the overactive immune response that leads to atopic dermatitis, thereby alleviating skin inflammation and severe itching. But because of their side effects, the treatment must be discontinued after some time.
How do the new treatments work?
New treatments known as biologics have been available for several years now. They work by slowing down the overactive immune system and blocking inflammatory signalling molecules. The active substance dupilumab, approved in 2017, blocks interleukins 4 and 13, while tralokinumab, approved in 2021, slows down interleukin 13. This causes the inflammation to wane and the skin to calm down. Dupilumab has now also been approved for adolescents and children six years and older.
Other biologics for treating atopic dermatitis are currently in clinical development. The substances are injected under the skin.
JAK inhibitors offer a different approach to atopic dermatitis treatment. The active substance baricitinib has been approved for adults with atopic dermatitis since October 2020, and the active substance upadacitinib since August 2021. JAK inhibitors are small molecules that are highly effective in inhibiting inflammation. They are taken as a tablet.
Unlike biologics, they do not stop individual messenger substances, but instead inhibit the transmission of inflammatory signals in the cell. As a result, the inflammation subsides along with the atopic dermatitis symptoms. Moreover, JAK inhibitors act quickly and their effects and side effects can be controlled very precisely. However, side effects include inflammation of the upper respiratory tract, headache and increased levels of creatine kinase (a laboratory value measuring the energy metabolism of muscle cells). It is therefore only used if the other treatments are inadequate.
Studies are currently underway on additional JAK inhibitors, which can be applied as a cream directly on the skin. This would significantly reduce the risk of side effects. However, none of these substances has yet been approved.
The experts of the German Dermatological Society recommend that these new treatments only be used if moderate to severe atopic dermatitis cannot be adequately managed with external (topical) drugs alone.
Sources
Schwichtenberg U. Press release of the German Dermatological Society (DDG) from 6 September 2021: Welt-Neurodermitis-Tag am 14. September: Systemisch wirkende Therapeutika verbessern Behandlung (World Atopic Eczema Day on 14 September: Systemic therapeutics improve treatment) (In German)
AWMF. Atopic Dermatitis Guidelines (atopic eczema; atopic dermatitis), AWMF register number: 013-027 (In German)
Worm M et al. Modern therapies in atopic dermatitis: biologics and small molecule drugs. J Dtsch Dermatol Ges. 2020 Jul 14