Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years: a Delphi consensus project mapping expert opinion in Northern Europe

Abstract

Background Paediatric atopic dermatitis (AD) can be burdensome, affecting mental health and impairing quality of life for children and caregivers. Comprehensive guidelines exist for managing paediatric AD, but practical guidance on using systemic therapy is limited, particularly for new therapies including biologics and Janus kinase (JAK) inhibitors, recently approved for various ages in this indication. Objectives This expert consensus aimed to provide practical recommendations within this advancing field to enhance clinical decision‐making on the use of these and other systemics for children and adolescents aged ≥2 years with moderate‐to‐severe AD. Methods Nineteen physicians from Northern Europe were selected for their expertise in managing childhood AD. Using a two‐round Delphi process, they reached full or partial consensus on 37 statements. Results Systemic therapy is recommended for children aged ≥2 years with a clear clinical diagnosis of severe AD and persistent disease uncontrolled after optimizing non‐systemic therapy. Systemic therapy should achieve long‐term disease control and reduce short‐term interventions. Recommended are cyclosporine A for short‐term use (all ages) and dupilumab or methotrexate for long‐term use (ages ≥6 years). Consensus was not reached on the best long‐term systemics for children aged 2–6 years, although new systemic therapies will likely become favourable: New biologics and JAK inhibitors will soon be approved for this age group, and more trial and real‐world data will become available. Conclusions This article makes practical recommendations on the use of systemic AD treatments for children and adolescents, to supplement international and regional guidelines. It considers the systemic medication that was available for children and adolescents with moderate‐to‐severe AD at the time this consensus project was done: azathioprine, cyclosporine A, dupilumab, methotrexate, mycophenolate mofetil and oral glucocorticosteroids. We focus on the geographically similar Northern European countries, whose healthcare systems, local preferences for AD management and reimbursement structures nonetheless differ significantly.

Improving Psychological Health Outcomes in Children with Atopic Dermatitis

“…A number of evidence-based clinical guidelines recommend a stepwise approach to treating childhood AD based on the degree of eczema severity. 19 Current recommended therapeutic options include emollients, topical treatments and systemic therapies.…”

Modern Interventions for Pediatric Atopic Dermatitis: An Updated Pharmacologic Approach

“…New European guidelines include both JAK inhibitors and DUPI for age > 6 years in addition to older systemic agents like azathioprine, methotrexate, and ciclosporin/cyclosporine for children and adolescents with severe disease [ 64 ]. On the basis of current evidence, new European guidelines, and expert consensus [ 64 , 65 ], our authors propose the following approach to treating pediatric patients with AD. Initial therapy should begin with topical treatments that include TCS and steroid-sparing agents.…”

Effectiveness and Safety of Dupilumab in Children Under 6 Years of Age with Moderate-to-Severe Atopic Dermatitis: A Retrospective Real-World Study

“…Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in childhood, affecting between 10 and 20% of children under 6 years of age [1]. At these stages, moderate-to-severe forms of the disease represent a true challenge given the paucity of scientific evidence and approved systemic treatments [2,3]. Paradoxically, earlier onset and more severe forms of AD may be associated with a longer-lasting disease and a greater association with atopic comorbidities [4].…”