治疗特应性皮炎新药及其临床药理学研究有关问题探讨

对近5年来特应性皮炎代表性新药的国内外批准情况进行介绍,总结了度普利尤单抗注射液、乌帕替尼缓释片、迪高替尼乳膏、克立硼罗软膏等4种不同作用机制、不同给药途径的特应性皮炎治疗药物的申报资料中临床药理学研究主要内容,以及国内外监管机构对特应性皮炎治疗药物的审评考量,旨在为特应性皮炎新药的早期临床研发和评价提供参考依据。     

Phase 1 study of crisaborole in Japanese healthy volunteers and patients with atopic dermatitis

Crisaborole ointment, 2%, is a non-steroidal phosphodiesterase 4 inhibitor for the treatment of mild to moderate atopic dermatitis (AD). This parallel-cohort, phase 1 study was conducted to investigate skin irritation potential and safety of crisaborole in healthy Japanese adults (cohort 1) and the safety and pharmacokinetic profile of crisaborole and metabolites AN7602 and AN8323 in Japanese adults with mild to moderate AD (cohort 2). In cohort 1, 20 healthy volunteers received single applications of crisaborole and vehicle simultaneously on separate locations under 48-h occlusion. In cohort 2, 12 patients with mild to moderate AD received crisaborole (n = 10) or vehicle (n = 2) twice daily for 8 days. Skin irritation and safety were assessed in cohort 1. Pharmacokinetics and safety were assessed in cohort 2. Skin irritation index (scale 0–400) was 40.0 for crisaborole and 5.0 for vehicle. No treatment-emergent adverse events (TEAE) were reported in cohort 1. The most common TEAE in the crisaborole group in cohort 2 were application site irritation (n = 7) and application site pain (n = 4). Crisaborole was rapidly absorbed, with limited systemic exposure between days 1 and 8 that was comparable with that seen in US-based participants in previous trials. Crisaborole had higher skin irritation than vehicle under occlusion in healthy Japanese adults and had an acceptable safety profile in Japanese adults with mild to moderate AD.     

The role of phosphodiesterase 4 in the pathophysiology of atopic dermatitis and the perspective for its inhibition

Atopic dermatitis (AD) is a highly prevalent, chronic inflammatory skin disease that affects children and adults. The pathophysiology of AD is complex and involves skin barrier and immune dysfunction. Many immune cytokine pathways are amplified in AD, including T helper (Th) 2, Th22, Th17 and Th1. Current treatment guidelines recommend topical medications as initial therapy; however, until recently, only two drug classes were available: topical corticosteroids (TCSs) and topical calcineurin inhibitors (TCIs). Several limitations are associated with these agents. TCSs can cause a wide range of adverse effects, including skin atrophy, telangiectasia, rosacea and acne. TCIs can cause burning and stinging, and the prescribing information lists a boxed warning for a theoretical risk of malignancy. Novel medications with new mechanisms of action are necessary to provide better long‐term control of AD. Phosphodiesterase 4 (PDE4) regulates cyclic adenosine monophosphate in cells and has been shown to be involved in the pathophysiology of AD, making it an attractive therapeutic target. Several PDE4 inhibitors are in clinical development for use in the treatment of AD, including crisaborole, which recently became the first topical PDE4 inhibitor approved for treatment of mild to moderate AD. This review will further describe the pathophysiology of AD, explain the possible role of PDE4 in AD and review PDE4 inhibitors currently approved or being investigated for use in AD.     

Atopic Dermatitis With a Focus on Moderate to Severe Disease

Atopic dermatitis (AD) affects nearly 10% of children and 7% of adults in the United States. Initial treatments for all patients with AD include vigilant skin hygiene and moisturizers. Other treatments, depending on disease severity, include topical corticosteroids, calcineurin inhibitors, or phototherapy as maintenance therapy to lengthen the time to relapse. Systemic immunosuppressants are recommended when these regimens are inadequate but are associated with poor side effect profiles. Recent discoveries are leading to more effective and safer immunomodulatory therapies. An overview of AD clinical pathways will focus on moderate to severe disease, including a discussion of the newest available treatment—dupilumab.     

Phosphodiesterase inhibitors and prostaglandin analogues in dermatology: A comprehensive review

Due to immune‐mediated nature, medicines with immunomodulatory and anti‐inflammatory effects can used to treat many dermatologic diseases. Phosphodiesterase and prostaglandins are involved in many inflammatory pathways that cause cutaneous disorders. Phosphodiesterase inhibitors (PDEIs) and prostaglandin analogues are currently employed to treat several dermatologic disorders. Given the few comprehensive reviews in this context, focusing on the dermatologic applications and efficacy of these medicines appears valuable. The present comprehensive review was, therefore, performed on the applications of PDEIs and prostaglandin analogues in different cutaneous disorders. All the relevant articles were selected to perform this review by searching databases such as Medline, Google Scholar, Scopus, and Web of Science. Oral PDEIs, especially apremilast, is an effective medicine in psoriasis and a number of other cutaneous disorders such as vitiligo. Topical PDEIs, including crisaborole ointment 2%, is a safe and effective treatment in atopic dermatitis. Prostaglandin analogues, especially their topical forms such as latanoprost and bimatoprost, have different applications in cutaneous disorders, including pigmentary disorders, especially vitiligo and hair repigmentation; for instance, bimatoprost is used for eyelash repigmentation. Prostaglandin analogues are also used in alopecia, including androgenetic alopecia and alopecia areata. Oral (apremilast) and topical (crisaborole) PDEIs and topical prostaglandin analogues, including latanoprost and bimatoprost, were found safe and effective in different skin diseases. In terms of efficiency and safety, these medicines compete with other medications of similar use even with higher efficacy and fewer side effects that necessitate further studies.     

Pharmacological management of atopic dermatitis in the elderly

ABSTRACT

Introduction

The prevalence of atopic dermatitis (AD) in geriatric populations of industrialized countries is currently estimated at 3-4% and continues to increase. AD is associated with significant morbidity, increased susceptibility to infection, and symptoms of pruritus and pain. Treatments may negatively affect elderly patients; thus, plans should be optimized for this population.     

Investigational drugs for atopic dermatitis

Introduction: Many novel medications and herbal medicines have claimed efficacy on atopic dermatitis (AD).

Areas covered: This review covers evidence on efficacy of topical and oral forms of novel and investigational drugs. Topical agents include emollients, phosphodiesterase E4 (PDE4) inhibitors, and topical herbs. There is little evidence that ceramides or natural moisturizing factors provide relief in AD. PDE4 inhibitors have shown promise as an effective topical treatment for mild-to-moderate AD with minimal adverse events, and dupilumab as an effective subcutaneous agent for the treatment of moderate-to-severe AD in adult patients with little adverse effects. However, only preliminary data are available for dupilumab in children with AD. The long-term effects of dupilumab are also not known. Potential new systemic treatments include a number of herbal concoctions.

Expert opinion: Randomized, double-blind placebo-controlled trials (RCTs) have demonstrated topical PDE4 inhibitors are effective and safe in the treatment of both children and adults with AD but further evaluations are needed. RCTs have also shown that subcutaneous dupilumab is an effective and safe agent for the treatment of AD in adults. Long-term effects of these topical and systemic investigational drugs are currently unavailable. Regarding herbal medications, scientific methods are often flawed and objective evidence is lacking.     

序贯外用地奈德乳膏与克立硼罗软膏治疗轻中度特应性皮炎的疗效和安全性

目的 探讨序贯外用0.05%地奈德乳膏与2%克立硼罗软膏治疗轻中度特应性皮炎（atopic dermatitis,AD的疗效、安全性及复发率。方法 选取2021年7月至2022年8月南通大学附属医院皮肤科门诊轻至中度AD患者179例，随机分为3组：序贯治疗组外用0.05%地奈德乳膏连续治疗2周后，换用2%克立硼罗软膏，继续治疗2周；地奈德组外用0.05%地奈德乳膏连续治疗2周，接着每周2次再治疗2周；克立硼罗组外用2%克立硼罗软膏连续治疗4周。比较3组患者治疗前后的特应性皮炎评分（scoring atopic dermatitis, SCORAD）、治疗后的临床疗效、不良反应发生率及随访停药4周后的复发率。结果 序贯治疗组治疗后的SCORAD评分为（6.69±6.31）分、有效率为82.5%，与地奈德组[（5.39±4.25）分，87.5%]比较，差异无统计学意义；与克立硼罗组[（11.25±8.82）分，54.7%]比较，差异有统计学意义（P=0.002）。序贯治疗组、地奈德组和克立硼罗组患者的复发率和不良反应发生率分别为12.8%、31.0%、13.8%和8.8%、22.9%、9....     

Evaluating crisaborole as a treatment option for atopic dermatitis

Introduction: Atopic dermatitis (AD) is a chronic and recurrent disease presenting with eczematous lesions and pruritus. It impacts patient and family quality of life, increases morbidity, and accounts for large health-care expenditures. Although nonpharmacologic, topical, and systemic treatments exist, management of AD remains challenging due to limited treatment options. Crisaborole is a topical small molecule inhibitor of phosphodiesterase 4 (PDE4), recently approved for the treatment of AD in the United States.

Areas covered: The authors review crisaborole in the management of AD based on Phase II, Phase III, and post-marketing studies. Pharmacologic properties such as chemistry, pharmacokinetics, pharmacodynamics and metabolism are discussed. A PubMed systematic review was augmented with Google Scholar searches via keyword, Medical Subject Headings (MeSH), and Boolean operation searches.

Expert opinion: Crisaborole showed modest efficacy in short-term trials, but head-to-head trials with topical corticosteroids and tacrolimus are needed to assess its clinical utility. Since crisaborole is non-steroidal, it may reduce the need for topical corticosteroids and address steroid phobia. However, it is likely to suffer from the same factors contributing to intentional non-adherence in topicals: dissatisfaction with efficacy and inconvenience.