Position statement: topical calcineurin inhibitors in atopic dermatitis. Fecha: Miércoles 24 de octubre de 2018
Position statement: topical calcineurin inhibitors in atopic dermatitis.
Authors:
Remitz A1, De Pità O2, Mota A3, Serra-Baldrich E4, Vakirlis E5, Kapp A6.
1 Department of Skin and Allergic diseases, Helsinki University Central Hospital, Helsinki, Finland.2 Department of Dermatology and Allergy, Cristo Re Hospital, Rome, Italy.
3 Department of Dermatology, Faculty of Medicine, University of Porto, i3S Research Institute, Porto, Portugal.
4 Department of Dermatology, Sant Pau Hospital, Autonomous University, Barcelona, Spain.
5 Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece.
6 Department of Dermatology and Allergy, Hannover Medical School, Hannover, Germany.
Abstract:
BACKGROUND:
Atopic dermatitis (AD) is a common inflammatory skin disease in both adults and children. Whilst topical calcineurin inhibitors (TCIs), tacrolimus ointment and pimecrolimus cream, have proven efficacy for the treatment of AD, it is important to involve experts to obtain their opinion on its optimal treatment.
OBJECTIVE:
Using a modified Delphi approach, this project aimed to generate consensus amongst experts on the use of TCIs in the treatment of AD, with a focus on the differentiation between tacrolimus and pimecrolimus.
METHODS:
Six expert Dermatologists from different European countries participated in this project based on their experience with AD and its treatment, which was evaluated by literature analysis and expert opinion. Consensus amongst the experts was generated using a modified Delphi approach, consisting of three distinct phases, during which a web meeting (June 2017), two online rounds of blinded Delphi voting (July-September 2017), and a face-to-face meeting (November 2017) were conducted. The consensus statements concerned two main topics: (i) Background of AD; and (ii) TCIs in AD. Hot topics in the treatment of AD not supported by meta-analysis, clinical trials or large observational studies were also discussed based on clinical experience.
RESULTS:
In total, 25 consensus statements were defined and validated: 8 statements on the general background of AD and 17 statements on the use of TCIs in AD, including their mechanism of action and therapeutic indications in AD, efficacy in adult and pediatric AD patients, pharmacokinetics, incidence of adverse events, and safety concerns. Hot topics on the use of TCIs for the treatment of AD, included: cream vs ointment, dosages, TCIs contact allergy, burning sensation management, superinfection, and vaccination concerns.
CONCLUSION:
TCIs are a suitable therapy for AD and selection of the specific TCI should be based on factors which differentiate tacrolimus from pimecrolimus.
DOI: https://doi.org/10.1111/jdv.15272
Asistentes: Dra. Ruth Helena Ramírez, Dr. Carlos Chinchilla, Dr. Jorge Sánchez, Dra. Susana Diez, Residentes: Yurlany Gutierrez, Susana Uribe, Gloria Gil, Catalina López, Jaime Sosa, Steven Abreu, Luis Carlos Santamaria, July Ospina, Ana María Calle
ResponderEliminarEl objetivo de este artículo de posición frente al uso de inhibidores tópicos de la calcineurina fue generar un consenso entre expertos sobre el uso de estos medicamentos en el tratamiento de dermatitis atópica, enfocándose en las diferencias entre tacrolimus y pimecrolimus.
Los inhibidores tópicos de la calcineurina son considerados una opción de tratamiento durante las exacerbaciones y como manejo proactivo (2 veces por semana) a largo plazo sin relacionarse con atrofia cutánea. Su uso se recomienda en áreas especiales como: intertriginosas, cara, región ano-genital, pero podría usarse en cualquier área del cuerpo.
El tacrolimus al 0.03% ha mostrado ser eficez en el tratamiento de dermatitis atópica moderada grave en niños, su formulación al 0.1% también podría considerarse principalmente en lesiones liquenificadas de extremidades. Su vehículo en ungüento ayuda a reestablecer la humectación de la piel.
El mecanismo de acción está en relación con la supresión de la síntesis de citocinas proinflamatorias y la inhibición de la activación de mastocitos, neutrófilos, basófilos y eosinófilos. Tienen una baja absorción sistémica, con baja incidencia de efectos adversos, dentro de los cuales se incluyen la sensación urente tras su aplicación la cual tiende a mejorar tras de la primera semana de uso y con el uso de analgésicos como ibuprofeno o acetaminofen. Tiene una mejor absorción cutánea el tacrolimus y dentro del perfil de seguridad desde 2006 se ha relacionado con el riesgo de linfomas principalmente cutáneos sin embargo a la fecha los estudios no encuentran una relación causal.