背景:几种全身疗法已被批准用于治疗重度AD。特别是,Janus激酶抑制剂(JAKI),包括abrocitinib,baricitinib,和upadacitinib,在多项临床试验中进行评估后,最近获得了用于治疗重度AD患者的批准.然而,人们对这些药物的长期安全性和实际临床实践中这些药物的管理提出了一些担忧.在本文中,我们描述了Delphi共识的结果,该共识旨在描述有关JAKI和聚焦的知识,特别是,关于在日常实践中为皮肤科医生提供有关使用这些药物的临床建议。
方法:12位意大利皮肤科医生回顾了有关JAKI疗效和安全性的最新文献,并提出了24项陈述。
结果:就三个主要主题达成了共识:(1)在中重度AD患者中使用JAKi治疗;(2)不同表型的JAK抑制剂的有效性和安全性;(3)在临床实践中使用JAKi治疗患者的不同方法。小组就所有发言提出了几项建议。
结论:鉴于JAKI在临床实践中的广泛应用,为每个患者的表型建立特定的随访是至关重要的,以实现可能的最佳临床结局并将潜在的不良事件降至最低.
BACKGROUND: Several systemic therapies have been approved for the treatment of severe AD. In particular, Janus kinase inhibitors (JAKi), including abrocitinib, baricitinib, and
upadacitinib, recently received approval for the treatment of patients with severe AD after being evaluated in several clinical trials. However, a few concerns have been raised regarding their long-term safety and the management of these drugs in real-world clinical practice. In this article we described the results of a Delphi
consensus aimed at describing the knowledge on JAKi and focusing, in particular, on providing clinical recommendations for dermatologists in daily practice regarding the use of these drugs.
METHODS: Twelve Italian dermatologists reviewed the most recent literature regarding the efficacy and safety profiles of JAKi and proposed 24 statements.
RESULTS: Agreement was reached for statements focusing on three main topics: (1) place in therapy of JAKi in patients with moderate-to-severe AD; (2) effectiveness and safety of JAK inhibitors in different phenotypes; (3) different approaches to the management of patients treated with JAKi in clinical practice. The panel proposed several recommendations regarding all the statements.
CONCLUSIONS: Given the wide use of JAKi in clinical practice, it is crucial to establish a specific follow-up for each patient\'s phenotype in order to achieve the best possible clinical outcome and minimize potential adverse events.