Eczema - Emerging treatments | BMJ Best Practice

Lebrikizumab

Lebrikizumab, a novel investigational high-affinity monoclonal antibody targeting IL-13, demonstrated rapid, dose-dependent efficacy in adults with moderate to severe eczema.[165] Lebrikizumab is approved in Europe (but not the US) for the treatment of moderate to severe eczema in adults and children aged ≥12 years with a body weight of at least 40 kg who are candidates for systemic therapy.[166]

Nemolizumab

Nemolizumab is an investigational humanised monoclonal antibody against IL-31 receptor A. Several trials have demonstrated significantly improved pruritus in adults with moderate to severe eczema; further data on adverse effects are needed.[167][168][169][170][171]

Omalizumab

Omalizumab is a recombinant humanised monoclonal antibody that inhibits the high-afﬁnity Fc receptor of IgE. It is currently approved for the treatment of chronic idiopathic urticaria and moderate to severe persistent asthma in patients with a positive skin test or in vitro reactivity to a perennial aeroallergen. In one randomised placebo-controlled clinical trial, subcutaneous omalizumab significantly reduced eczema severity and improved quality of life in a paediatric population with atopy and severe eczema, despite highly elevated total immunoglobulin E levels at baseline.[172]

Orismilast

Orismilast, an investigational phosphodiesterase-4 (PDE4) inhibitor, has been granted fast track designation by the US Food and Drug Administration (FDA) for the treatment of moderate to severe eczema.[173]

Retinoids

Oral retinoids may be of benefit in patients with hand eczema refractory to topical treatments and/or phototherapy. One Cochrane review reported that, for patients with severe chronic hand eczema, there is high-certainty evidence that alitretinoin improves symptom control. The benefit became more apparent with higher-dose alitretinoin.[174] Alitretinoin is only available as a topical formulation in the US, but is available as an oral formulation in other countries.

Dietary alterations

Evidence does not support specific maternal dietary interventions or allergen avoidance during pregnancy for prevention of atopic disease in children. There is some evidence to suggest that dietary antigen avoidance by lactating mothers may reduce the severity of eczema in infants, and reduce the risk of developing eczema in children of high-risk women; larger trials are required.[41] While probiotic treatment has been promoted as a preventative measure, the available data are of low or very low quality.[42][43][44] Of note, the FDA has issued a warning that preterm infants should not be given probiotics due to risk of invasive bacterial or fungal disease.[175]