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Aktueller Stand zur Systemtherapie bei atopischer Dermatitis

Welche Faktoren bestimmen die Therapieauswahl?

Modern systemic therapies for atopic dermatitis

Which factors determine the choice of therapy?

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Zusammenfassung

Für die Therapie der moderaten bis schweren atopischen Dermatitis (AD) stehen mittlerweile zwei Gruppen an modernen Systemtherapien zur Verfügung, die aktuell fünf Substanzen umfassen: Biologika (Dupilumab, Tralokinumab) und „small molecules“ (Abrocitinib, Baricitinib, Upadacitinib). Das wachsende Armamentarium an neuen Therapieoptionen stellt die Behandler zunehmend vor neue Herausforderungen im Hinblick auf die Auswahl des passenden Präparates für den individuellen Fall. In diesem Übersichtsbeitrag werden die Therapievoraussetzungen und -bedingungen sowohl der jeweiligen Medikamentengruppen sowie auch der Einzelsubstanzen komparativ dargestellt. Hierbei wird zum einen der direkte Effekt auf die Erkrankungsschwere betrachtet und ferner das Spektrum an möglichen unerwünschten Arzneimittelwirkungen diskutiert. Insbesondere kurz- und langfristige Wirkungen, das Sicherheitsprofil sowie die Begleiterkrankungen können als Entscheidungsfaktoren für eine patientenindividuelle Therapieauswahl zugrunde gelegt werden.

Abstract

For the treatment of moderate to severe atopic dermatitis (AD), two groups of modern systemic therapies with a total of five drugs are currently approved in Germany: biologics (dupilumab, tralokinumab) and “small molecules” (abrocitinib, baricitinib, upadacitinib). The growing armamentarium of therapy options, especially with more than one drug per substance group, makes it challenging for practitioners to select the appropriate treatment for the individual patient. In this review article, the preconditions and requirements of each drug group as well as the corresponding substances are presented comparatively. On the one hand, direct therapeutic effects on the severity of the disease are considered and, on the other hand, the spectrum of potential adverse drug reactions are discussed. In particular, short- and long-term effects, the safety profile and the patient’s concomitant diseases represent key factors for shared decision-making with regard to select the optimum personalized therapy option

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  1. Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    Stephan Traidl & Annice Heratizadeh

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Correspondence to Stephan Traidl.

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S. Traidl deklariert Beratungstätigkeiten für Leo Pharma, La Roche-Posay und Lilly. A. Heratizadeh deklariert Honorare für Vortrags- oder Beratungstätigkeiten von Leo Pharma, Abbvie, Novartis, Pierre Fabre, Sanofi, Beiersdorf, Hans Karrer, Ziarco, Nutricia, Meda, Lilly und ein Reisekosten-Stipendium von Janssen und Kongressgebühren-Stipendien von Janssen und Abbvie.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Termini, wie z. B. Behandler, Patient, Arzt, implizieren alle 3 Geschlechter (weiblich, männlich, divers), auch wenn diese nur in einer Form verwendet werden.

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Supplementary Information

Checklisten für die Indikationsstellung einer Systemtherapie bei atopischer Dermatitis.

Die Checklisten umfassen objektive, subjektive sowie Therapieparameter zur Beurteilung, ob eine Systemtherapie indiziert ist zur Behandlung der atopischen Dermatitis. A) Indikationsstellung bei Kindern, B) Jugendlichen und C) Erwachsenen. Publiziert in Augustin M, Werfel T, von Kiedrowski R. Checkliste: Indikationsstellung zur Systemtherapie der Neurodermitis bei Erwachsenen. (Internet). 2018 (cited 2022 Feb 28). Available from: https://www.awmf.org/leitlinien/detail/ll/013-027.html

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Traidl, S., Heratizadeh, A. Aktueller Stand zur Systemtherapie bei atopischer Dermatitis. Dermatologie 73, 529–537 (2022). https://doi.org/10.1007/s00105-022-05003-7

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