Risk Assessment in Atopic Dermatitis: Guidance from a Multidisciplinary Expert Panel.

IF 3.5 3区 医学 Q1 DERMATOLOGY
Alessandra Narcisi, Vito Di Lernia, Maria Esposito, Vittorio Forte, Silvia Mariel Ferrucci, Lorenzo Gerratana, Pietro Morrone, Saverio Muscoli, Maddalena Napolitano, Michela Ortoncelli, Marina Talamonti
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Abstract

Guidelines recommend that patients with severe atopic dematitis (AD) be treated with Janus kinase inhibitors (JAKi). Recently, the safety of JAKi as a class was reviewed by the European Medicines Agency, leading to a modification of the Summaries of Product Characteristics. For upadacitinib, changes involve reduced posology and restriction of its use to patients with no other alternative amongst the elderly and those at an increased risk of major adverse cardiovascular events (MACE), cancer and venous thromboembolism (VTE). Risk assessment may be daunting and clarity regarding definitions and data is needed. An interdisciplinary workshop, termed the Multiple In-treatment Risk Assessment & Management, was conceived to provide dermatologists with a platform for multidisciplinary exchange on risk assessment in patients with MACE, cancer and VTE to correctly recognise patients with increased risk. In this review, we characterised common and less common patient profiles in order to assess the risk. With the cooperation of a cardiologist, oncologist, respiratory medicine specialist and haematologists, we identified the risk factors for MACE, cancer and VTE. The results show that taking a careful medical history is the basis of risk assessment and that a careful medical history should be performed regardless of the intended therapy in AD. We propose that risk levels be used in the general population as a benchmark to evaluate risk levels in patients with AD, and provide a checklist to support such risk assessments in routine clinical practice. Our work provides a clear framework for risk assessment to the community of dermatologists and, therefore, contributes to improving the standard of care in AD.

特应性皮炎的风险评估:多学科专家小组的指导。
指南建议严重特应性痴呆(AD)患者用Janus激酶抑制剂(JAKi)治疗。最近,欧洲药品管理局对JAKi作为一个类别的安全性进行了审查,导致对产品特性摘要进行了修改。对于upadacitinib,变化包括降低了其危害,限制其用于老年人和主要不良心血管事件(MACE)、癌症和静脉血栓栓塞(VTE)风险增加的患者。风险评估可能令人望而生畏,需要明确定义和数据。一个跨学科研讨会,被称为多重治疗风险评估与管理,旨在为皮肤科医生提供一个多学科交流的平台,以评估MACE、癌症和静脉血栓栓塞患者的风险,以正确识别风险增加的患者。在这篇综述中,我们描述了常见和不常见的患者概况,以评估风险。在心脏病专家、肿瘤学专家、呼吸内科专家和血液学专家的合作下,我们确定了MACE、癌症和静脉血栓栓塞的危险因素。结果表明,仔细的病史是风险评估的基础,无论对阿尔茨海默病进行何种治疗,都应进行仔细的病史调查。我们建议在普通人群中使用风险水平作为评估AD患者风险水平的基准,并提供一份清单来支持常规临床实践中的风险评估。我们的工作为皮肤科医生提供了一个明确的风险评估框架,因此有助于提高AD的护理标准。
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来源期刊
Dermatology and Therapy
Dermatology and Therapy Medicine-Dermatology
CiteScore
6.00
自引率
8.80%
发文量
187
审稿时长
6 weeks
期刊介绍: Dermatology and Therapy is an international, open access, peer-reviewed, rapid publication journal (peer review in 2 weeks, published 3–4 weeks from acceptance). The journal is dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of dermatological therapies. Studies relating to diagnosis, pharmacoeconomics, public health and epidemiology, quality of life, and patient care, management, and education are also encouraged. Areas of focus include, but are not limited to all clinical aspects of dermatology, such as skin pharmacology; skin development and aging; prevention, diagnosis, and management of skin disorders and melanomas; research into dermal structures and pathology; and all areas of aesthetic dermatology, including skin maintenance, dermatological surgery, and lasers. The journal is of interest to a broad audience of pharmaceutical and healthcare professionals and publishes original research, reviews, case reports/case series, trial protocols, and short communications. Dermatology and Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an International and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of quality research, which may be considered of insufficient interest by other journals. The journal appeals to a global audience and receives submissions from all over the world.
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