TY - JOUR

T1 - Systemic treatment of children and adolescents with atopic dermatitis aged ≥2 years

T2 - a Delphi consensus project mapping expert opinion in Northern Europe

AU - de Graaf, M.

AU - Janmohamed, S. R.

AU - Schuttelaar, M. L.A.

AU - Agner, T.

AU - Alfonso, J. H.

AU - De Schepper, S.

AU - Deleuran, M.

AU - Despontin, K.

AU - Elenius, V.

AU - Ghislain, P. D.

AU - Huilaja, L.

AU - Johansson, E. K.

AU - Kvenshagen, B. K.

AU - Mandelin, J. M.

AU - Olset, H.

AU - Svensson, A.

AU - van Tuyll van Serooskerken, A. M.

AU - Thyssen, J. P.

AU - Vestergaard, C.

N1 - Funding Information: This Delphi project was funded by Sanofi Genzyme. The expert panel was invited by the study sponsor but remained independent, having not been appointed by any national dermatological society or regulatory authority from any of the respective countries. Funding Information: AMvTvS is an advisor for AbbVie, LEO Pharma, Novartis and UCB Pharma and an advisor and speaker for Sanofi Genzyme. BKK is a speaker for ALK, AstraZeneca, Sanofi Genzyme and the Norwegian Medical Association. She has stock or stock options in Juvenilia AS, Majamed AS and Barneleg1. CV is an advisor, consultant or investigator for AbbVie, Sanofi Genzyme, Novartis, LEO Pharma, MSD, and Pfizer. He has received research grants from Pfizer, LEO Pharma and Novartis. EKJ has received speaker honoraria and/or been a consultant for Sanofi Genzyme, LEO Pharma, ACO, Novartis, AbbVie. HO is a consultant for Pfizer. JMM is an advisor, consultant, speaker or investigator for AbbVie, Eli Lilly, LEO Pharma, Orion Pharma and Sanofi Genzyme. JPT is an advisor, consultant, speaker and investigator for AbbVie, Arena Pharmaceuticals, Pfizer, LEO Pharma, Regeneron, Sanofi Genzyme, Almirall, ASLAN, OM‐85 and Coloplast. He has received research grants from Regeneron, Pfizer and Sanofi Genzyme. KD is an advisor, consultant, speaker or investigator for Sanofi Genzyme, LEO Pharma and AbbVie. She has received grants from LEO Pharma and AbbVie. LH is an advisor, consultant, speaker or investigator for Novartis, Eli Lilly, LEO Pharma, AbbVie, Sanofi Genzyme, Orion Pharma and Pfizer. MD is an advisor, consultant or investigator for AbbVie, Sanofi Genzyme, Regeneron, LEO Pharma, Pfizer, Arena Pharmaceuticals, La Roche Posay, Novartis, Almirall, Pierre Fabre and Eli Lilly. She has received grants from LEO Pharma, AbbVie, Eli Lilly, Regeneron, Sanofi Genzyme and Pfizer. MdG is an advisor, consultant, speaker or investigator for Sanofi Genzyme, LEO Pharma and Eli Lilly. She had received grants from Sanofi Genzyme and Regeneron. MLAS is an advisor, consultant, speaker and/or investigator for AbbVie, Pfizer, LEO Pharma, Regeneron, Sanofi Genzyme, Eli Lilly and Galderma. She has received grants from Regeneron and Sanofi Genzyme, Novartis and Pfizer. PDG is an advisor, speaker, consultant or investigator for AbbVie, Janssen, LEO Pharma, Novartis, UCB Pharma, Amgen, Eli Lilly, Galderma, BMS, Meda, Maruho, Flen, Menarini, Almirall, Boehringer Ingelheim and Viatris. SRJ is an advisor or speaker for, or has received honoraria from, Novartis, Sanofi Genzyme, Janssen and LEO Pharma. He has received grants from Pierre Fabre. TA is an advisor, consultant, speaker and/or investigator for AbbVie, Pfizer, LEO Pharma, Sanofi Genzyme and Eli Lilly. VE is a speaker for Sanofi Genzyme. All other authors have no conflicts of interest to declare.

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

U2 - 10.1111/jdv.18410

DO - 10.1111/jdv.18410

M3 - Journal article

C2 - 35793471

AN - SCOPUS:85134169979

VL - 36

SP - 2153

EP - 2165

JO - Journal of the European Academy of Dermatology and Venereology

JF - Journal of the European Academy of Dermatology and Venereology

SN - 0926-9959

IS - 11

ER -