Updated consensus guidelines for management of moderate-to-severe atopic dermatitis in Singapore: Integrating biologics, Janus kinase inhibitors and conventional therapies.
10.47102/annals-acadmedsg.2024158
- Author:
Yik Weng YEW
1
;
Uma ALAGAPPAN
2
;
Derrick AW
3
;
Nisha Suyien CHANDRAN
4
;
Karen Jl CHOO
5
;
Roland CHU
6
;
Hong Yi KOH
7
;
Mark Jean Aan KOH
8
;
Shan Xian LEE
9
;
Ching Yin NEOH
10
;
Siyun Lucinda TAN
1
;
Mark TANG
11
;
Yong-Kwang TAY
9
;
Seth FRANCIS-GRAHAM
12
;
Andrew LIM
13
;
Haur Yueh LEE
5
Author Information
1. National Skin Centre, Singapore.
2. The Dermatology Clinic, Parkway East Specialist Hospital, Singapore.
3. Department of Dermatology, Sengkang General Hospital, Singapore.
4. Division of Dermatology, Department of Medicine, National University Hospital, Singapore.
5. Department of Dermatology, Singapore General Hospital, Singapore.
6. Loke Skin Clinic, Novena Medical Center, Singapore.
7. TSN Dermatology Skin Specialist Clinic, Gleneagles Medical Centre, Singapore.
8. Department of Dermatology, KK Women's and Children's Hospital, Singapore.
9. Department of Dermatology, Changi General Hospital, Singapore.
10. Specialist Skin Clinic, Singapore.
11. The Skin Specialists and Laser Clinic, Mount Alvernia Hospital, Singapore.
12. Costello Medical, London, UK.
13. Costello Medical, Singapore.
- Publication Type:Review
- Keywords:
Janus kinase inhibitors;
biologics;
calcineurin inhibitors;
corticosteroids;
eczema;
phosphodiesterase-4 inhibitors
- MeSH:
Dermatitis, Atopic/drug therapy*;
Humans;
Singapore;
Janus Kinase Inhibitors/therapeutic use*;
Biological Products/therapeutic use*;
Delphi Technique;
Consensus;
Antibodies, Monoclonal, Humanized/therapeutic use*;
Severity of Illness Index;
Bridged Bicyclo Compounds, Heterocyclic/therapeutic use*;
Dermatologic Agents/therapeutic use*;
Practice Guidelines as Topic;
Pyrimidines/therapeutic use*;
Boron Compounds
- From:Annals of the Academy of Medicine, Singapore
2024;53(11):670-682
- CountrySingapore
- Language:English
-
Abstract:
INTRODUCTION:Since 2016, several therapies have been approved for treating atopic dermatitis (AD) in Singapore, including biologics, oral Janus kinase (JAK) inhibitors and topical crisaborole. This study supplements the 2016 Singapore treatment guidelines for AD, focusing on newer therapies for moderate-to-severe disease, while revisiting older treatment regimens to accommodate changes in knowledge and practice.
METHOD:A modified Delphi panel was held, led by 2 co-chairs. The voting expert panel consisted of 12 dermatologists experienced in managing AD in Singapore. Delphi survey rounds were conducted between 24 July and 27 October 2023. Panellists indicated their agreement with drafted statements using a 5-point Likert scale. Consensus was defined as ≥80% agreement. An expert meeting was held to facilitate the consensus process between rounds 1 and 2 of voting.
RESULTS:All expert panellists participated in both survey rounds, with a 100% response rate. Thirty-nine statements, classified into general principles, conventional treatments, biologics and JAK inhibitors, were proposed. Of these, 27 statements reached consensus at the end of round 1. After the expert meeting, 17 statements were included in round 2, of which 16 statements reached consensus. One statement did not reach consensus. Key updates are the inclusion of dupilumab and JAK inhibitors as potential first-line treatments for moderate-to-severe AD, in certain populations.
CONCLUSION:This modified Delphi study generated consensus among Singapore dermatology experts, to update treatment guidelines in moderate-to-severe atopic dermatitis. The consensus statements developed are intended to supplement the 2016 Singapore treatment guidelines for AD. Further revisions may be required when new evidence and/or treatments become available.
