Inibidores de Janus quinase (JAK)
Vários inibidores de JAK são aprovados pela Food and Drug Administration (FDA) dos EUA para a dermatite atópica (por exemplo, abrocitinibe, upadacitinibe e ruxolitinibe).[46]Blauvelt A, Teixeira HD, Simpson EL, et al. Efficacy and safety of upadacitinib vs dupilumab in adults with moderate-to-severe atopic dermatitis: a randomized clinical trial. JAMA Dermatol. 2021 Sep 1;157(9):1047-55.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340015
http://www.ncbi.nlm.nih.gov/pubmed/34347860?tool=bestpractice.com
[47]Simpson EL, Sinclair R, Forman S, et al. Efficacy and safety of abrocitinib in adults and adolescents with moderate-to-severe atopic dermatitis (JADE MONO-1): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet. 2020 Jul 25;396(10246):255-66.
http://www.ncbi.nlm.nih.gov/pubmed/32711801?tool=bestpractice.com
[48]Papp K, Szepietowski JC, Kircik L, et al. Efficacy and safety of ruxolitinib cream for the treatment of atopic dermatitis: results from 2 phase 3, randomized, double-blind studies. J Am Acad Dermatol. 2021 Oct;85(4):863-72.
https://www.jaad.org/article/S0190-9622(21)00931-2/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/33957195?tool=bestpractice.com
O ruxolitinibe está disponível como formulação tópica, enquanto o abrocitinibe e o upadacitinibe estão disponíveis apenas como formulações orais. Existem também vários inibidores de JAK em estudos de fase 3, incluindo o baricitinibe, o delgocitinibe e o PF-04965842.[49]Simpson EL, Lacour JP, Spelman L, et al. Baricitinib in patients with moderate-to-severe atopic dermatitis and inadequate response to topical corticosteroids: results from two randomized monotherapy phase III trials. Br J Dermatol. 2020 Aug;183(2):242-55.
http://www.ncbi.nlm.nih.gov/pubmed/31995838?tool=bestpractice.com
[50]Nakagawa H, Nemoto O, Igarashi A, et al. Delgocitinib ointment, a topical Janus kinase inhibitor, in adult patients with moderate to severe atopic dermatitis: a phase 3, randomized, double-blind, vehicle-controlled study and an open-label, long-term extension study. J Am Acad Dermatol. 2020 Apr;82(4):823-31.
https://www.jaad.org/article/S0190-9622(19)33289-X/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/32029304?tool=bestpractice.com
[51]ClinicalTrials.gov. JAK1 inhibitor with medicated topical therapy in adolescents with atopic dermatitis (JADE TEEN). April [internet publication].
https://clinicaltrials.gov/ct2/show/NCT03796676
Dupilumab
O dupilumabe, um anticorpo monoclonal dirigido contra a interleucina (IL)-4 e a IL-13, está aprovado nos EUA e na Europa para o tratamento da dermatite atópica moderada a grave e tem sido utilizado off-label no tratamento da DAC.[52]Johnson H, Adler BL, Yu J. Dupilumab for allergic contact dermatitis: an overview of its use and impact on patch testing. Cutis. 2022 May;109(5):265-7.
http://www.ncbi.nlm.nih.gov/pubmed/35856769?tool=bestpractice.com
No entanto, o dupilumabe precisa ser testado em ensaios clínicos para essa indicação, pois as evidências atuais são baseadas em relatos de casos e estudos retrospectivos.[53]Stout M, Silverberg JI. Variable impact of dupilumab on patch testing results and allergic contact dermatitis in adults with atopic dermatitis. J Am Acad Dermatol. 2019 Jul;81(1):157-62.
http://www.ncbi.nlm.nih.gov/pubmed/30885752?tool=bestpractice.com
[54]Raffi J, Suresh R, Botto N, et al. The impact of dupilumab on patch testing and the prevalence of comorbid allergic contact dermatitis in recalcitrant atopic dermatitis: a retrospective chart review. J Am Acad Dermatol. 2020 Jan;82(1):132-8.
http://www.ncbi.nlm.nih.gov/pubmed/31562940?tool=bestpractice.com