Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement

A M Drucker, K Eyerich, M S de Bruin-Weller, J P Thyssen, P I Spuls, A D Irvine, G Girolomoni, S Dhar, C Flohr, D F Murrell, A S Paller, E Guttman-Yassky, A M Drucker, K Eyerich, M S de Bruin-Weller, J P Thyssen, P I Spuls, A D Irvine, G Girolomoni, S Dhar, C Flohr, D F Murrell, A S Paller, E Guttman-Yassky

Abstract

Background: Guidelines discourage the use of systemic corticosteroids for atopic dermatitis (AD), but their use remains widespread.

Objectives: To reach consensus among an international group of AD experts on the use of systemic corticosteroids for AD.

Methods: A survey consisting of statements accompanied by visual analogue scales ranging from 'strongly disagree' to 'neutral' to 'strongly agree' was distributed to the International Eczema Council (IEC). Consensus was reached in agreement on a statement if < 30% of respondents marked to the left of 'neutral' towards 'strongly disagree'.

Results: Sixty of 77 (78%) IEC members participated. Consensus was reached on 12 statements, including that systemic corticosteroids should generally be avoided but can be used rarely for severe AD under certain circumstances, including a lack of other treatment options, as a bridge to other systemic therapies or phototherapy, during acute flares in need of immediate relief, in anticipation of a major life event or in the most severe cases. If used, treatment should be limited to the short term. Most respondents agreed that systemic corticosteroids should never be used in children, but consensus was not reached on that statement. The conclusions of our expert group are limited by a dearth of high-quality published evidence. If more stringent consensus criteria were applied (e.g. requiring < 20% of respondents marking towards 'strongly disagree'), consensus would have been reached on fewer statements.

Conclusions: Based on expert opinion from the IEC, routine use of systemic corticosteroids for AD is generally discouraged and should be reserved for special circumstances.

Conflict of interest statement

A.M.D. is an investigator and has received research funding from Sanofi and Regeneron, is a consultant for Sanofi and RTI Health Solutions, and has received honoraria from Astellas Canada, Prime Inc. and Spire Learning. K.E. has received honoraria (advisor/speaker) from AbbVie, Almirall, Berlin Chemie, Eli Lilly, Hexal, Janssen and Novartis. M.S.d.B.‐W. is a principal investigator for Regeneron/Sanofi/Genzyme, AbbVie, Roche and Novartis, an advisory board member for Regeneron/Sanofi/Genzyme, AbbVie and Anacor, and a consultant for Regeneron/Sanofi/Genzyme. J.P.T. is supported by an unrestricted grant from the Lundbeck Foundation and has attended advisory boards for Roche and Sanofi Genzyme and received a speaker's honorarium from LEO Pharma. P.I.S. has been a consultant for LEO Pharma, Anacor, AbbVie and Novartis, has received research funding from Schering Plough and LEO Pharma, and has been an investigator for AbbVie, Astellas, Almirall, Amgen, Boehringer Ingelheim, Celgene, Centocor, Clinitude, Dermira, Janssen (Cilag), LEO Pharma, Lilly, Novartis, Pfizer, Regeneron and Roche. A.D.I. has been a consultant for Sanofi Regeneron, Genentech and Chugai. G.G. has been principal investigator in clinical trials sponsored by and/or and has received personal fees from AbbVie, Abiogen, Almirall, Amgen, Bayer, Biogen, Celgene, Eli‐Lilly, Galderma, Hospira, Janssen, LEO Pharma, Merck, MSD, Mundipharma, Novartis, Pfizer, Pierre Fabre, Regeneron, Sandoz, Sanofi and Sun Pharma. S.D. has been an advisory board member and key opinion leader for and has received honoraria from Galderma, Sanofi and Novartis. D.F.M. is an investigator for Regeneron, Novartis and Anacor, and a consultant for Sanofi, Novartis and Anacor. A.S.P. is a consultant with honoraria for Eli Lilly, Galderma, GSK/Stiefel, Pfizer, Pierre Fabre, Puricore, Regeneron/Sanofi, Roivant and Valeant, and an investigator for LEO, Novartis, Pfizer and Roivant. E.G.‐Y. has received research support, consulting or lecture fees on atopic dermatitis from Regeneron, Sanofi, Merck, Stiefel/GSK, Pfizer, Genentech, Bristol‐Myers Squibb, Galderma, Celgene, LEO Pharma, Janssen, Medimmune, Dermira, Anacor, AnaptysBio, Glenmark, Novartis, AbbVie, Sun Pharma, Mitsubishi Tanabe, Vitae, Allergan, Almirall, Puricore, Asana Biosciences, Gilead, Concert, Immune, Kyowa Kirin, Ziarco and DS Biopharma. E.G.Y. has no patents, ownership or financial gain from any atopic dermatitis drug.

© 2017 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.

References

    1. Ring J, Alomar A, Bieber T et al Guidelines for treatment of atopic eczema (atopic dermatitis) Part II. J Eur Acad Dermatol Venereol 2012; 26:1176–93.
    1. Sidbury R, Davis DM, Cohen DE et al Guidelines of care for the management of atopic dermatitis: section 3. Management and treatment with phototherapy and systemic agents. J Am Acad Dermatol 2014; 71:327–49.
    1. Wollenberg A, Oranje A, Deleuran M et al ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J Eur Acad Dermatol Venereol 2016; 30:729–47.
    1. Saeki H, Nakahara T, Tanaka A et al Clinical practice guidelines for the management of atopic dermatitis 2016. J Dermatol 2016; 43:1117–45.
    1. Kim JE, Kim HJ, Lew BL et al Consensus guidelines for the treatment of atopic dermatitis in Korea (part II): systemic treatment. Ann Dermatol 2015; 27:578–92.
    1. Rubel D, Thirumoorthy T, Soebaryo RW et al Consensus guidelines for the management of atopic dermatitis: an Asia‐Pacific perspective. J Dermatol 2013; 40:160–71.
    1. Schneider L, Tilles S, Lio P et al Atopic dermatitis: a practice parameter update 2012. J Allergy Clin Immunol 2013; 131:295–9.
    1. Dutch Society of Dermatology and Venereology (NVDV) . Dutch atopic dermatitis guideline. Available at: (last accessed 19 January 2018) (in Dutch).
    1. Arkwright PD, Motala C, Subramanian H et al Management of difficult‐to‐treat atopic dermatitis. J Allergy Clin Immunol Pract 2013; 1:142–51.
    1. Roekevisch E, Spuls PI, Kuester D et al Efficacy and safety of systemic treatments for moderate‐to‐severe atopic dermatitis: a systematic review. J Allergy Clin Immunol 2014; 133:429–38.
    1. Schmitt J, Schakel K, Folster‐Holst R et al Prednisolone vs. ciclosporin for severe adult eczema. An investigator‐initiated double‐blind placebo‐controlled multicentre trial. Br J Dermatol 2010; 162:661–8.
    1. Heddle RJ, Soothill JF, Bulpitt CJ et al Combined oral and nasal beclomethasone diproprionate in children with atopic eczema: a randomised controlled trial. Br Med J (Clin Res Ed) 1984; 289:651–4.
    1. La Rosa M, Musarra I, Ranno C et al A randomized, double‐blind, placebo‐controlled, crossover trial of systemic flunisolide in the treatment of children with severe atopic dermatitis. Curr Ther Res 1995; 56:720–6.
    1. Caplan A, Fett N, Rosenbach M et al Prevention and management of glucocorticoid‐induced side effects: A comprehensive review. Infectious complications and vaccination recommendations. J Am Acad Dermatol 2017; 76:191–8.
    1. Caplan A, Fett N, Rosenbach M et al Prevention and management of glucocorticoid‐induced side effects: A comprehensive review. Gastrointestinal and endocrinologic side effects. J Am Acad Dermatol 2017; 76:11–16.
    1. Caplan A, Fett N, Rosenbach M et al Prevention and management of glucocorticoid‐induced side effects: A comprehensive review. A review of glucocorticoid pharmacology and bone health. J Am Acad Dermatol 2017; 76:1–9.
    1. Waljee AK, Rogers MA, Lin P et al Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ 2017; 357:j1415.
    1. Aljebab F, Choonara I, Conroy S. Systematic review of the toxicity of long‐course oral corticosteroids in children. PLOS ONE 2017; 12:e0170259.
    1. Simpson EL, Bieber T, Eckert L et al Patient burden of moderate to severe atopic dermatitis (AD): insights from a phase 2b clinical trial of dupilumab in adults. J Am Acad Dermatol 2016; 74:491–8.
    1. Schmitt J, Abraham S, Trautmann F et al Usage and effectiveness of systemic treatments in adults with severe atopic eczema: first results of the German Atopic Eczema Registry TREATgermany. J Dtsch Dermatol Ges 2017; 15:49–59.
    1. Schmitt J, Schmitt NM, Kirch W et al Outpatient care and medical treatment of children and adults with atopic eczema. J Dtsch Dermatol Ges 2009; 7:345–51.
    1. Taylor K, Swan DJ, Affleck A et al Treatment of moderate‐to‐severe atopic eczema in adults within the U.K.: results of a national survey of dermatologists. Br J Dermatol 2017; 176:1617–23.
    1. Proudfoot LE, Powell AM, Ayis S et al The European TREatment of severe Atopic eczema in children Taskforce (TREAT) survey. Br J Dermatol 2013; 169:901–9.
    1. Totri CR, Eichenfield LF, Logan K et al Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: the PeDRA TREAT survey. J Am Acad Dermatol 2017; 76:281–5.
    1. Harris PA, Taylor R, Thielke R et al Research electronic data capture (REDCap) – a metadata‐driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42:377–81.
    1. Schmitt J, Spuls P, Boers M et al Towards global consensus on outcome measures for atopic eczema research: results of the HOME II meeting. Allergy 2012; 67:1111–17.
    1. Redelmeier DA, Tversky A. Discrepancy between medical decisions for individual patients and for groups. N Engl J Med 1990; 322:1162–4.
    1. Hoesing H. Clinical Practice Guidelines: Closing the Gap Between Theory and Practice. Oakbrook Terrace, IL: Joint Commission International, 2016.
    1. Gerbens LA, Boyce AE, Wall D et al TREatment of ATopic eczema (TREAT) Registry Taskforce: protocol for an international Delphi exercise to identify a core set of domains and domain items for national atopic eczema registries. Trials 2017; 18:87.
    1. Dhar S, Parikh D, Srinivas S et al Treatment guidelines for atopic dermatitis by Indian Society for Pediatric Dermatology task force 2016 – Part‐3: systemic therapies. Indian J Ped Dermatol 2017; 18:274–280.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe