RESUMO
Introducción: La dermatitis atópica es una enfermedad cutánea inflamatoria, crónica y pruriginosa. De etiología multifactorial que se produce con mayor frecuencia durante la lactancia y en la infancia temprana. Objetivos: Describir la evidencia científica sobre el efecto de los inhibidores de janus quinasa sobre la mejoría clínica y la remisión de la dermatitis atópica. Métodos: Se realizará una revisión sistemática y metaanálisis. Esta revisión sistemática se regirá de acuerdo con las directrices PRISMA. Se realizó una búsqueda en PubMed, Scopus, Web of Science. Resultados: Se incluyeron 14 artículos en la revisión. Conclusiones: El tratamiento con inhibidores del janus cinasas, como el abrocitinib, está siendo investigado como una opción potencial para el tratamiento de la dermatitis atópica y los artículos incluidos en esta revisión han demostrado resultados prometedores. El abrocitinib mostró una mejora sostenible de los síntomas de la dermatitis atópica, ha demostrado ser bien tolerado en los ensayos clínicos, con menor cantidad e intensidad de efectos secundarios, respeto a otros fármacos como cremas o corticoides sistémicos, y hasta el momento sugieren que los inhibidores de la janus cinasas son bien tolerados por la mayoría de los pacientes. Es importante destacar que el abrocitinib aún es una terapia relativamente nueva y su uso a largo plazo en el tratamiento de la dermatitis atópica requieren más investigaciones.
Introduction: Atopic dermatitis is an inflammatory, chronic, pruritic skin disease. It has a multifactorial etiology and occurs most frequently during infancy and early childhood. Aims: To describe the scientific evidence on the effect of janus kinase inhibitors on clinical improvement and remission of atopic dermatitis. Methods: A systematic review and meta-analysis will be performed. This systematic review will be conducted according to PRISMA guidelines. A search will be performed in Pubmed, Scopus, Web of Science. Results: 14 articles were included in the review. Conclusions: Treatment with janus kinase inhibitors, such as abrocitinib, is being investigated as a potential option for the treatment of atopic dermatitis and the articles included in this review have shown promising results. abrocitinib showed a sustainable improvement of atopic dermatitis symptoms, has been shown to be well tolerated in clinical trials, with fewer and less intense side effects compared to other drugs such as creams or systemic corticosteroids, and so far suggest that janus kinase inhibitors are well tolerated by most patients. Importantly, abrocitinib is still a relatively new therapy and its long-term use in the treatment of atopic dermatitis requires further investigations.
RESUMO
BACKGROUND: In the last decade, new therapies with different mechanisms of action have been approved for the treatment of moderate to severe Crohn's disease (CD) and ulcerative colitis (UC). Due to the lack of comparative head-to-head trials, the ideal positioning of agents as the most appropriate first- or second-line therapies remains to be defined. OBJECTIVE: This survey aimed to evaluate the perception and decisions of Brazilian Inflammatory Bowel Diseases (IBD) specialists in positioning of new therapies (vedolizumab [VEDO], ustekinumab [UST] and tofacitinib [TOFA]) in the management of IBD in different clinical scenarios. METHODOLOGY: An anonymous national web-based questionnaire was used to determine the positioning of treatment options in different clinical scenarios (using Google Forms platform), which involved different age ranges, phenotypes, clinical situations and previous exposure to anti-TNF agents (14 scenarios for CD and 10 scenarios for UC). In CD, physicians could choose between UST or VEDO, whilst in UC, between UST, VEDO or TOFA. Six reasons for the specific choice were proposed, such as mechanism of action, safety, method of administration or onset of action. Statistical analysis was carried out with chi-square and t-tests. RESULTS: A total of 150 out of 672 GEDIIB IBD specialists (22.32%) responded to the survey. In CD scenarios, UST was the most dominant choice (11/14 scenarios), with VEDO dominating only 3 clinical situations. In UC scenarios, VEDO was the dominant choice (8/10), with UST being chosen for scenarios that included extraintestinal manifestations. Among the reasons for specific choices, the most commonly chosen were the higher efficacy due to the intrinsic mechanism of action and safety profile. CONCLUSIONS: UST was the dominant choice as compared to VEDO in CD in most scenarios, especially due to its mechanism of action and safety. VEDO was the dominant choice as compared to UST and TOFA in UC scenarios, mainly for reasons also related to its mechanism of action and safety profile. Comparative studies including patient outcomes are needed to better define the positioning of new IBD therapeutic options in our country.
Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Brasil , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/tratamento farmacológico , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Internet , Percepção , Inibidores do Fator de Necrose Tumoral , Ustekinumab/uso terapêuticoRESUMO
A dermatite atópica canina ganha destaque mundial pela alta incidência e recentes descobertas sobre sua complexa fisiopatogenia. Este estudo avaliou os efeitos da terapia com oclacitinib a sobre o escore de prurido de 20 cães com dermatite atópica, diagnosticados com estritos critérios de exclusão, em três momentos (dias 0, 14 e 28) segundo escalas quantitativa e qualitativa, na óptica dos proprietários. A terapia via oral reduziu em mais de 50% a intensidade do prurido em 85% dos cães, em doses de 0,4 a 0,6 mg/kg a cada 12 horas. O uso da mesma dose a cada 24 horas mostrou que 80% dos animais obtiveram redução do prurido, em média de 44%. Não houve reações adversas ao uso do ativo nos 28 dias de avaliação. O oclacitinib ' mostrou ser eficiente no tratamento de cães com dermatite atópica, com altos índices de redução de prurido em ambas as posologias, sobretudo no uso a cada 12 horas.
La dermatitis atópica canina tiene destaque mundial por su alta incidencia y recientes descubrimientos acerca de su compleja fisiopatogenia. El presente estudio evaluó los efectos de la terapia con oclacitinib sobre la puntuación de prurito de 20 perros; con dermatitis atópica diagnosticada en base a estrictos criterios de exclusión, en tres momentos (días 0, 14 Y 28), según escalas cuantitativa y cualitativa, en la observación del propietario. La terapia redujó en más de un 50% la intensidad del prurito en el 85% de los perros cuando se utilizó la dosis de 0,4-0,6 mg/kg cada 12 horas por vía oral. El uso de la misma dosis cada 24 horas mostró reducción del prurito en el 80% de los animales, con reducción média de el 44%. Ninguno de los perros presentó efectos adversos con el uso del principio activo durante la prueba de 28 días. El oclacitinib mostró ser eficiente para el tratamiento de perros con dermatitis atópica, con altos índices de reducción de prurito en ambas posologías, sobre todo cuando del uso cada 12 horas.
Canine atopic dermatitis gains worldwide attention due to its high incidence, and to recent discoveries about its complex pathophysiology. This study evaluated the effects of oclacitinib on pruritus scores of 20 dogs with atopic dermatitis. Levels of pruritus described by owners were diagnosed based on strict exclusion criteria, at 3 moments (days 0, 14 and 28), by quantitative and qualitative scales. In 85% of the dogs, oral admnistration of 0.4 - 0.6 mg/kg twice daily resulted in more than 50% reduction in pruritus leveI. The same dose once daily reduced pruritus in 80% of the animals, being 44% the average reduction. None of them presented adverse reactions during the 28 days of evaluation. Oclacitinib has shown efficiency in the treatment of dogs with atopic dermatitis, with high rates of pruritus reduction in both dosages, especially when used every 12 hours.
Assuntos
Animais , Adulto , Cães , Dermatite Atópica/diagnóstico , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/veterinária , Janus Quinase 1/farmacologia , Pesos e Medidas , Prurido/veterináriaRESUMO
A dermatite atópica canina ganha destaque mundial pela alta incidência e recentes descobertas sobre sua complexa fisiopatogenia. Este estudo avaliou os efeitos da terapia com oclacitinib a sobre o escore de prurido de 20 cães com dermatite atópica, diagnosticados com estritos critérios de exclusão, em três momentos (dias 0, 14 e 28) segundo escalas quantitativa e qualitativa, na óptica dos proprietários. A terapia via oral reduziu em mais de 50% a intensidade do prurido em 85% dos cães, em doses de 0,4 a 0,6 mg/kg a cada 12 horas. O uso da mesma dose a cada 24 horas mostrou que 80% dos animais obtiveram redução do prurido, em média de 44%. Não houve reações adversas ao uso do ativo nos 28 dias de avaliação. O oclacitinib ' mostrou ser eficiente no tratamento de cães com dermatite atópica, com altos índices de redução de prurido em ambas as posologias, sobretudo no uso a cada 12 horas.(AU)
La dermatitis atópica canina tiene destaque mundial por su alta incidencia y recientes descubrimientos acerca de su compleja fisiopatogenia. El presente estudio evaluó los efectos de la terapia con oclacitinib sobre la puntuación de prurito de 20 perros; con dermatitis atópica diagnosticada en base a estrictos criterios de exclusión, en tres momentos (días 0, 14 Y 28), según escalas cuantitativa y cualitativa, en la observación del propietario. La terapia redujó en más de un 50% la intensidad del prurito en el 85% de los perros cuando se utilizó la dosis de 0,4-0,6 mg/kg cada 12 horas por vía oral. El uso de la misma dosis cada 24 horas mostró reducción del prurito en el 80% de los animales, con reducción média de el 44%. Ninguno de los perros presentó efectos adversos con el uso del principio activo durante la prueba de 28 días. El oclacitinib mostró ser eficiente para el tratamiento de perros con dermatitis atópica, con altos índices de reducción de prurito en ambas posologías, sobre todo cuando del uso cada 12 horas.(AU)
Canine atopic dermatitis gains worldwide attention due to its high incidence, and to recent discoveries about its complex pathophysiology. This study evaluated the effects of oclacitinib on pruritus scores of 20 dogs with atopic dermatitis. Levels of pruritus described by owners were diagnosed based on strict exclusion criteria, at 3 moments (days 0, 14 and 28), by quantitative and qualitative scales. In 85% of the dogs, oral admnistration of 0.4 - 0.6 mg/kg twice daily resulted in more than 50% reduction in pruritus leveI. The same dose once daily reduced pruritus in 80% of the animals, being 44% the average reduction. None of them presented adverse reactions during the 28 days of evaluation. Oclacitinib has shown efficiency in the treatment of dogs with atopic dermatitis, with high rates of pruritus reduction in both dosages, especially when used every 12 hours.(AU)