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.
OBJECTIVE: 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.
OBJECTIVE: 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.
摘要：
背景：儿科特应性皮炎（AD）可能是繁重的，影响儿童和护理人员的心理健康和生活质量。存在管理儿科AD的全面指南，但是使用系统治疗的实际指导是有限的，特别是对于包括生物制剂和Janus激酶（JAK）抑制剂在内的新疗法，最近批准在这个适应症的不同年龄。
目的：本专家共识旨在在这一进展领域内提供切实可行的建议，以加强对2岁以上中重度AD儿童和青少年使用这些系统和其他系统的临床决策。
方法：选择了来自北欧的19名医生，因为他们在管理儿童AD方面具有专业知识。使用两轮Delphi过程，他们就37项声明达成了全部或部分共识。
结果：对于年龄≥2岁、临床明确诊断为严重AD且在优化非系统治疗后未控制的持续性疾病的儿童，建议进行系统治疗。系统治疗应实现疾病的长期控制，减少短期干预。建议短期使用环孢素A（所有年龄段），长期使用dupilumab或甲氨蝶呤（年龄≥6岁）。尚未就2-6岁儿童的最佳长期系统达成共识，尽管新的全身疗法可能会变得有利：新的生物制剂和JAK抑制剂将很快被批准用于该年龄组，和更多的试验和现实世界的数据将变得可用。
结论：本文就儿童和青少年使用全身性AD治疗提出了切实可行的建议，补充国际和区域准则。它考虑了在这个共识项目完成时可用于患有中度至重度AD的儿童和青少年的全身性药物：硫唑嘌呤，环孢菌素A,dupilumab,甲氨蝶呤,霉酚酸酯和口服糖皮质激素。我们关注地理上相似的北欧国家，他们的医疗系统，尽管如此，当地对AD管理和报销结构的偏好差异很大。
目的：本专家共识旨在在这一进展领域内提供切实可行的建议，以加强对2岁以上中重度AD儿童和青少年使用这些系统和其他系统的临床决策。
方法：选择了来自北欧的19名医生，因为他们在管理儿童AD方面具有专业知识。使用两轮Delphi过程，他们就37项声明达成了全部或部分共识。
结果：对于年龄≥2岁、临床明确诊断为严重AD且在优化非系统治疗后未控制的持续性疾病的儿童，建议进行系统治疗。系统治疗应实现疾病的长期控制，减少短期干预。建议短期使用环孢素A（所有年龄段），长期使用dupilumab或甲氨蝶呤（年龄≥6岁）。尚未就2-6岁儿童的最佳长期系统达成共识，尽管新的全身疗法可能会变得有利：新的生物制剂和JAK抑制剂将很快被批准用于该年龄组，和更多的试验和现实世界的数据将变得可用。
结论：本文就儿童和青少年使用全身性AD治疗提出了切实可行的建议，补充国际和区域准则。它考虑了在这个共识项目完成时可用于患有中度至重度AD的儿童和青少年的全身性药物：硫唑嘌呤，环孢菌素A,dupilumab,甲氨蝶呤,霉酚酸酯和口服糖皮质激素。我们关注地理上相似的北欧国家，他们的医疗系统，尽管如此，当地对AD管理和报销结构的偏好差异很大。
