Atopic Dermatitis

Concerns about the side effects of topical corticosteroids continue to be a source of anxiety for parents of children with atopic dermatitis (AD), leading some medical providers to prescribe weaker products, Nanette B. Silverberg, MD, said at the Revolutionizing Atopic Dermatitis meeting.

Up to 40% of parents of children with chronic AD cite anxiety surrounding corticosteroids, according to Dr. Silverberg, chief of pediatric dermatology at the Mount Sinai Health System, New York.

When the potential for adverse events are explained to parents who are anxious about a drug, “they take it in a different way than other individuals,” noted Dr. Silverberg, clinical professor of pediatrics and dermatology at Icahn School of Medicine at Mount Sinai.

In a systematic review of 16 studies examining topical corticosteroid phobia in AD, published between 1946 and 2016, the prevalence of corticosteroid phobia among patients with AD or their caregivers ranged from 21% to 83.7%, with definitions of phobia that ranged from “concern” to “irrational fear.” In two studies where adherence was evaluated, patients with corticosteroid phobia had a higher rate of partial adherence (49.4%) or nonadherence (14.1%) when compared with patients who didn’t have a phobia of corticosteroids (29.3 % and 9.8%, respectively)..

The source of these fears can be information from friends, relatives, media, the Internet, as well as doctors, Dr. Silverberg noted. “We have to be responsible for providing proper data to these individuals,” she said.

Primary care providers also treat young children with AD differently from older children, when compared with other specialties, according to the results of one study that involved a survey and a retrospective chart review, published in 2020. In the survey, 88% of primary care providers in Chicago said they managed AD differently in children under aged 2 years than in older children, with 65% reporting they were more likely to refer a child under 2 years to a specialist, and 64% said they were less likely to prescribe high-potency topical corticosteroids to children in this age group. The retrospective review found that at PCP visits, significantly more children with AD between aged 2 and 5 years were more likely to be prescribed medium-potency topical corticosteroids (0.66% vs. 0.37%, P < .01) and high-potency topical corticosteroids (0.15% vs. 0.05%; P < .01) than children under 2 years old, respectively.

Of the children who had seen a specialist, more dermatologists (57%) prescribed medium-potency and high-potency topical corticosteroids for children under aged 2 years than did allergists (30%) and pediatricians (15%) (P < .01), according to the study.

“These are our colleagues who are often very strong prescribers using systemic agents, and only 15% of pediatricians will do this,” Dr. Silverberg said. “We’re really looking at a big divide between us and other subspecialties and primary care, and [topical corticosteroids] are frequently underutilized because of these fears.”

In another study looking at the use of topical corticosteroids for AD in the pediatric emergency department (mean age of patients, 6.3 years), from 2012 to 2017, patients at 46 of 167 visits were prescribed over-the-counter topical hydrocortisone, while at 63 of 167 visits, patients were not prescribed or recommended any corticosteroid.

The mean class of the topical corticosteroid prescribed was 5.5, and the most commonly recommended corticosteroid was class 7 (the least potent available) in 61 of 104 patients (P < .001). A dermatologist was consulted in 14 of 167 visits (8.6%), and in those cases, topical corticosteroids were often prescribed (P = .018), as was a higher class of corticosteroids (a mean of 3.1 vs. 5.9; P < .001).

Topical corticosteroids also tend to be prescribed less by internal medicine physicians than by family medicine physicians or dermatologists. A 2020 study of ambulatory care data in the United States from 2006 to 2016 found that internists were 22 times less likely to prescribe topical corticosteroids for AD compared with dermatologists (5.1% vs. 52.2%; P = .001). But there was no significant difference in prescribing between family medicine physicians and dermatologists (39.1% vs. 52.2%, P = .27).

“We know they [corticosteroids] work, but so many people are fearful of them ... even with a low, low side effect profile,” Dr. Silverberg said.

For children with AD, corticosteroid use is “suboptimal” across the United States, with evidence that Medicaid-insured pediatric patients with AD are less likely to see a specialist and less likely to be prescribed high-potency topical corticosteroids compared with commercially-insured patients.

 

Discussing efficacy and safety
 

Dr. Silverberg said providers who care for children with AD should talk about the fear surrounding these medications and educate parents with anxiety surrounding corticosteroids. “Side effects are usually short term and limited, so we really can assure parents that there is a long safety profile,” she said.

Asked to comment on this topic, Adelaide Hebert, MD, professor of dermatology and director of pediatric dermatology at the University of Texas, Houston, said that she often sees concerns surrounding the use of topical corticosteroids, both in her practice with parents and when teaching residents in other disciplines, such as pediatrics, family medicine, and emergency medicine.

“We don’t do a good job in medical school educating the students about the safety, applicability, and proper use of topical steroids, and I think that leads to some of the confusion when it comes to properly using this class of medications in treating atopic dermatitis,” she said in an interview.

The use of a high-potency topical steroid is important, she noted, as lower doses may not adequately control AD. “If the patient has very mild disease, this may be just fine,” she noted. Those patients often do not see a pediatric dermatologist, “but the ones with moderate or severe atopic dermatitis often do, and I would say [the problem of] undertreatment is all too common.”

Like Dr. Silverberg, Dr. Hebert said that in her clinical experience, side effects from topical corticosteroids have been rare. “I could count on one hand the number of patients in a 38-year pediatric dermatology practice where they had an adverse effect from a topical steroid,” she said.

Dr. Silverberg reports receiving consulting fees from Amryt Pharma, Galderma, Incyte, and Vyne; non-CME related fees from Pfizer and Regeneron; and contracted research fees from Incyte and the Vitiligo Research Foundation. Dr. Hebert reports receiving research funds from GSK, Leo, Ortho Dermatologics, Galderma, Dermavant, Pfizer, and Arcutis Biotherapeutics paid to her institution; honoraria from Pfizer, Arcutis, Incyte; and having served on the data safety monitoring board for Regeneron-Sanofi, GSK, and Ortho Dermatologics.

Concerns about the side effects of topical corticosteroids continue to be a source of anxiety for parents of children with atopic dermatitis (AD), leading some medical providers to prescribe weaker products, Nanette B. Silverberg, MD, said at the Revolutionizing Atopic Dermatitis meeting.

Up to 40% of parents of children with chronic AD cite anxiety surrounding corticosteroids, according to Dr. Silverberg, chief of pediatric dermatology at the Mount Sinai Health System, New York.

When the potential for adverse events are explained to parents who are anxious about a drug, “they take it in a different way than other individuals,” noted Dr. Silverberg, clinical professor of pediatrics and dermatology at Icahn School of Medicine at Mount Sinai.

In a systematic review of 16 studies examining topical corticosteroid phobia in AD, published between 1946 and 2016, the prevalence of corticosteroid phobia among patients with AD or their caregivers ranged from 21% to 83.7%, with definitions of phobia that ranged from “concern” to “irrational fear.” In two studies where adherence was evaluated, patients with corticosteroid phobia had a higher rate of partial adherence (49.4%) or nonadherence (14.1%) when compared with patients who didn’t have a phobia of corticosteroids (29.3 % and 9.8%, respectively)..

The source of these fears can be information from friends, relatives, media, the Internet, as well as doctors, Dr. Silverberg noted. “We have to be responsible for providing proper data to these individuals,” she said.

Primary care providers also treat young children with AD differently from older children, when compared with other specialties, according to the results of one study that involved a survey and a retrospective chart review, published in 2020. In the survey, 88% of primary care providers in Chicago said they managed AD differently in children under aged 2 years than in older children, with 65% reporting they were more likely to refer a child under 2 years to a specialist, and 64% said they were less likely to prescribe high-potency topical corticosteroids to children in this age group. The retrospective review found that at PCP visits, significantly more children with AD between aged 2 and 5 years were more likely to be prescribed medium-potency topical corticosteroids (0.66% vs. 0.37%, P < .01) and high-potency topical corticosteroids (0.15% vs. 0.05%; P < .01) than children under 2 years old, respectively.

Of the children who had seen a specialist, more dermatologists (57%) prescribed medium-potency and high-potency topical corticosteroids for children under aged 2 years than did allergists (30%) and pediatricians (15%) (P < .01), according to the study.

“These are our colleagues who are often very strong prescribers using systemic agents, and only 15% of pediatricians will do this,” Dr. Silverberg said. “We’re really looking at a big divide between us and other subspecialties and primary care, and [topical corticosteroids] are frequently underutilized because of these fears.”

In another study looking at the use of topical corticosteroids for AD in the pediatric emergency department (mean age of patients, 6.3 years), from 2012 to 2017, patients at 46 of 167 visits were prescribed over-the-counter topical hydrocortisone, while at 63 of 167 visits, patients were not prescribed or recommended any corticosteroid.

The mean class of the topical corticosteroid prescribed was 5.5, and the most commonly recommended corticosteroid was class 7 (the least potent available) in 61 of 104 patients (P < .001). A dermatologist was consulted in 14 of 167 visits (8.6%), and in those cases, topical corticosteroids were often prescribed (P = .018), as was a higher class of corticosteroids (a mean of 3.1 vs. 5.9; P < .001).

Topical corticosteroids also tend to be prescribed less by internal medicine physicians than by family medicine physicians or dermatologists. A 2020 study of ambulatory care data in the United States from 2006 to 2016 found that internists were 22 times less likely to prescribe topical corticosteroids for AD compared with dermatologists (5.1% vs. 52.2%; P = .001). But there was no significant difference in prescribing between family medicine physicians and dermatologists (39.1% vs. 52.2%, P = .27).

“We know they [corticosteroids] work, but so many people are fearful of them ... even with a low, low side effect profile,” Dr. Silverberg said.

For children with AD, corticosteroid use is “suboptimal” across the United States, with evidence that Medicaid-insured pediatric patients with AD are less likely to see a specialist and less likely to be prescribed high-potency topical corticosteroids compared with commercially-insured patients.

 

Discussing efficacy and safety
 

Dr. Silverberg said providers who care for children with AD should talk about the fear surrounding these medications and educate parents with anxiety surrounding corticosteroids. “Side effects are usually short term and limited, so we really can assure parents that there is a long safety profile,” she said.

Asked to comment on this topic, Adelaide Hebert, MD, professor of dermatology and director of pediatric dermatology at the University of Texas, Houston, said that she often sees concerns surrounding the use of topical corticosteroids, both in her practice with parents and when teaching residents in other disciplines, such as pediatrics, family medicine, and emergency medicine.

“We don’t do a good job in medical school educating the students about the safety, applicability, and proper use of topical steroids, and I think that leads to some of the confusion when it comes to properly using this class of medications in treating atopic dermatitis,” she said in an interview.

The use of a high-potency topical steroid is important, she noted, as lower doses may not adequately control AD. “If the patient has very mild disease, this may be just fine,” she noted. Those patients often do not see a pediatric dermatologist, “but the ones with moderate or severe atopic dermatitis often do, and I would say [the problem of] undertreatment is all too common.”

Like Dr. Silverberg, Dr. Hebert said that in her clinical experience, side effects from topical corticosteroids have been rare. “I could count on one hand the number of patients in a 38-year pediatric dermatology practice where they had an adverse effect from a topical steroid,” she said.

Dr. Silverberg reports receiving consulting fees from Amryt Pharma, Galderma, Incyte, and Vyne; non-CME related fees from Pfizer and Regeneron; and contracted research fees from Incyte and the Vitiligo Research Foundation. Dr. Hebert reports receiving research funds from GSK, Leo, Ortho Dermatologics, Galderma, Dermavant, Pfizer, and Arcutis Biotherapeutics paid to her institution; honoraria from Pfizer, Arcutis, Incyte; and having served on the data safety monitoring board for Regeneron-Sanofi, GSK, and Ortho Dermatologics.

Concerns about the side effects of topical corticosteroids continue to be a source of anxiety for parents of children with atopic dermatitis (AD), leading some medical providers to prescribe weaker products, Nanette B. Silverberg, MD, said at the Revolutionizing Atopic Dermatitis meeting.

Up to 40% of parents of children with chronic AD cite anxiety surrounding corticosteroids, according to Dr. Silverberg, chief of pediatric dermatology at the Mount Sinai Health System, New York.

When the potential for adverse events are explained to parents who are anxious about a drug, “they take it in a different way than other individuals,” noted Dr. Silverberg, clinical professor of pediatrics and dermatology at Icahn School of Medicine at Mount Sinai.

In a systematic review of 16 studies examining topical corticosteroid phobia in AD, published between 1946 and 2016, the prevalence of corticosteroid phobia among patients with AD or their caregivers ranged from 21% to 83.7%, with definitions of phobia that ranged from “concern” to “irrational fear.” In two studies where adherence was evaluated, patients with corticosteroid phobia had a higher rate of partial adherence (49.4%) or nonadherence (14.1%) when compared with patients who didn’t have a phobia of corticosteroids (29.3 % and 9.8%, respectively)..

The source of these fears can be information from friends, relatives, media, the Internet, as well as doctors, Dr. Silverberg noted. “We have to be responsible for providing proper data to these individuals,” she said.

Primary care providers also treat young children with AD differently from older children, when compared with other specialties, according to the results of one study that involved a survey and a retrospective chart review, published in 2020. In the survey, 88% of primary care providers in Chicago said they managed AD differently in children under aged 2 years than in older children, with 65% reporting they were more likely to refer a child under 2 years to a specialist, and 64% said they were less likely to prescribe high-potency topical corticosteroids to children in this age group. The retrospective review found that at PCP visits, significantly more children with AD between aged 2 and 5 years were more likely to be prescribed medium-potency topical corticosteroids (0.66% vs. 0.37%, P < .01) and high-potency topical corticosteroids (0.15% vs. 0.05%; P < .01) than children under 2 years old, respectively.

Of the children who had seen a specialist, more dermatologists (57%) prescribed medium-potency and high-potency topical corticosteroids for children under aged 2 years than did allergists (30%) and pediatricians (15%) (P < .01), according to the study.

“These are our colleagues who are often very strong prescribers using systemic agents, and only 15% of pediatricians will do this,” Dr. Silverberg said. “We’re really looking at a big divide between us and other subspecialties and primary care, and [topical corticosteroids] are frequently underutilized because of these fears.”

In another study looking at the use of topical corticosteroids for AD in the pediatric emergency department (mean age of patients, 6.3 years), from 2012 to 2017, patients at 46 of 167 visits were prescribed over-the-counter topical hydrocortisone, while at 63 of 167 visits, patients were not prescribed or recommended any corticosteroid.

The mean class of the topical corticosteroid prescribed was 5.5, and the most commonly recommended corticosteroid was class 7 (the least potent available) in 61 of 104 patients (P < .001). A dermatologist was consulted in 14 of 167 visits (8.6%), and in those cases, topical corticosteroids were often prescribed (P = .018), as was a higher class of corticosteroids (a mean of 3.1 vs. 5.9; P < .001).

Topical corticosteroids also tend to be prescribed less by internal medicine physicians than by family medicine physicians or dermatologists. A 2020 study of ambulatory care data in the United States from 2006 to 2016 found that internists were 22 times less likely to prescribe topical corticosteroids for AD compared with dermatologists (5.1% vs. 52.2%; P = .001). But there was no significant difference in prescribing between family medicine physicians and dermatologists (39.1% vs. 52.2%, P = .27).

“We know they [corticosteroids] work, but so many people are fearful of them ... even with a low, low side effect profile,” Dr. Silverberg said.

For children with AD, corticosteroid use is “suboptimal” across the United States, with evidence that Medicaid-insured pediatric patients with AD are less likely to see a specialist and less likely to be prescribed high-potency topical corticosteroids compared with commercially-insured patients.

 

Discussing efficacy and safety
 

Dr. Silverberg said providers who care for children with AD should talk about the fear surrounding these medications and educate parents with anxiety surrounding corticosteroids. “Side effects are usually short term and limited, so we really can assure parents that there is a long safety profile,” she said.

Asked to comment on this topic, Adelaide Hebert, MD, professor of dermatology and director of pediatric dermatology at the University of Texas, Houston, said that she often sees concerns surrounding the use of topical corticosteroids, both in her practice with parents and when teaching residents in other disciplines, such as pediatrics, family medicine, and emergency medicine.

“We don’t do a good job in medical school educating the students about the safety, applicability, and proper use of topical steroids, and I think that leads to some of the confusion when it comes to properly using this class of medications in treating atopic dermatitis,” she said in an interview.

The use of a high-potency topical steroid is important, she noted, as lower doses may not adequately control AD. “If the patient has very mild disease, this may be just fine,” she noted. Those patients often do not see a pediatric dermatologist, “but the ones with moderate or severe atopic dermatitis often do, and I would say [the problem of] undertreatment is all too common.”

Like Dr. Silverberg, Dr. Hebert said that in her clinical experience, side effects from topical corticosteroids have been rare. “I could count on one hand the number of patients in a 38-year pediatric dermatology practice where they had an adverse effect from a topical steroid,” she said.

Dr. Silverberg reports receiving consulting fees from Amryt Pharma, Galderma, Incyte, and Vyne; non-CME related fees from Pfizer and Regeneron; and contracted research fees from Incyte and the Vitiligo Research Foundation. Dr. Hebert reports receiving research funds from GSK, Leo, Ortho Dermatologics, Galderma, Dermavant, Pfizer, and Arcutis Biotherapeutics paid to her institution; honoraria from Pfizer, Arcutis, Incyte; and having served on the data safety monitoring board for Regeneron-Sanofi, GSK, and Ortho Dermatologics.

• Dupilumab is a subcutaneous injection therapy that inhibits the interleukin 4-receptor alpha subunit. It was approved in the United States for the treatment of adults with moderate to severe AD in 2017 and has since been approved for children and adolescents down to 6 years of age. Ungar and colleagues studied the effects of dupilumab on SARS-CoV-2 antibody responses in patients with moderate to severe AD. They previously found that dupilumab was associated with milder COVID-19 illness. In this study, they similarly found that dupilumab was associated with lower immunoglobulin G (IgG) antibody levels to SARS-CoV-2, consistent with less severe COVID-19 illness. Future studies are needed to confirm these results. However, these results reassure that taking dupilumab does not pose any major harms in regard to COVID-19 outcomes.

• My patients with AD ask me on an almost daily basis about whether they should get vaccinated for SARS-CoV-2. I recommended that my patients get vaccinated, based on data from vaccine studies. However, there has been a dearth of data on the efficacy and safety of SARS-CoV-2 specifically in AD patients. Kridin and colleagues performed a population-based cohort study including 77,682 adults with AD, of which 58,582 patients had completed two doses of the BioNTech-Pfizer SARS-CoV-2 mRNA vaccine. They found that patients with AD who received both vs no vaccine doses had significantly lower risk for COVID-19, hospitalization, and mortality. These are the best data to date in support of SARS-CoV-2 vaccination in patients with AD. Of note, there was no significant impact of immunosuppressive drugs on vaccine efficacy against COVID-19. However, previous studies in other immune-mediated disorders suggest that immunosuppressants may lower vaccine immune responses.^1,2 Some authors have advocated for temporarily discontinuing immunosuppressive agents for 1-2 weeks before and after administering SARS-CoV-2 vaccines. Currently, there is insufficient evidence to make strong recommendations.

Numerous in utero and early-life risk factors for AD have been examined over the years. Maternal stress and depression have been considered as potential risk factors for AD in children.

• My research group showed a while back that depression during pregnancy and in the postpartum period was associated with higher likelihood of AD in children.³
• Kawaguchi and colleagues recently analyzed data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan, including 8377 mother-child dyads where the child had not developed AD by the age of 1 year. They found that mothers with vs without psychological distress in both prenatal and postnatal periods or even only in the postnatal period had significantly increased risk of their children developing AD at 1-2 years of age. It seems prudent that mothers try to minimize stress during pregnancy and postpartum, though, understandably, this is not always feasible. Additionally, children of mothers who experience a lot of stress during pregnancy or postpartum may benefit from closer surveillance for the development of AD and other atopic diseases.

Additional References

1.         Dayam RM, Law JC, Goetbebuer RL, et al. Accelerated waning of immunity to SARS-CoV-2 mRNA vaccines in patients with immune mediated inflammatory diseases. JCI Insight. 2022 (Apr 26). Doi: 10.1172/jci.insight.159721   Source

2.         Medeiros-Ribeiro AC, Bonfiglioli KR, Domiciano DS, et al. Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis. Ann Rheum Dis. 2022;81:710-719. Doi: 10.1136/annrheumdis-2021-221735 Source

3.         McKenzie C, Silverberg JI. Maternal depression and atopic dermatitis in American children and adolescents. Dermatitis. 2020;31:75-80. Doi: 10.1097/DER.0000000000000548 Source

• Dupilumab is a subcutaneous injection therapy that inhibits the interleukin 4-receptor alpha subunit. It was approved in the United States for the treatment of adults with moderate to severe AD in 2017 and has since been approved for children and adolescents down to 6 years of age. Ungar and colleagues studied the effects of dupilumab on SARS-CoV-2 antibody responses in patients with moderate to severe AD. They previously found that dupilumab was associated with milder COVID-19 illness. In this study, they similarly found that dupilumab was associated with lower immunoglobulin G (IgG) antibody levels to SARS-CoV-2, consistent with less severe COVID-19 illness. Future studies are needed to confirm these results. However, these results reassure that taking dupilumab does not pose any major harms in regard to COVID-19 outcomes.

• My patients with AD ask me on an almost daily basis about whether they should get vaccinated for SARS-CoV-2. I recommended that my patients get vaccinated, based on data from vaccine studies. However, there has been a dearth of data on the efficacy and safety of SARS-CoV-2 specifically in AD patients. Kridin and colleagues performed a population-based cohort study including 77,682 adults with AD, of which 58,582 patients had completed two doses of the BioNTech-Pfizer SARS-CoV-2 mRNA vaccine. They found that patients with AD who received both vs no vaccine doses had significantly lower risk for COVID-19, hospitalization, and mortality. These are the best data to date in support of SARS-CoV-2 vaccination in patients with AD. Of note, there was no significant impact of immunosuppressive drugs on vaccine efficacy against COVID-19. However, previous studies in other immune-mediated disorders suggest that immunosuppressants may lower vaccine immune responses.^1,2 Some authors have advocated for temporarily discontinuing immunosuppressive agents for 1-2 weeks before and after administering SARS-CoV-2 vaccines. Currently, there is insufficient evidence to make strong recommendations.

Numerous in utero and early-life risk factors for AD have been examined over the years. Maternal stress and depression have been considered as potential risk factors for AD in children.

• My research group showed a while back that depression during pregnancy and in the postpartum period was associated with higher likelihood of AD in children.³
• Kawaguchi and colleagues recently analyzed data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan, including 8377 mother-child dyads where the child had not developed AD by the age of 1 year. They found that mothers with vs without psychological distress in both prenatal and postnatal periods or even only in the postnatal period had significantly increased risk of their children developing AD at 1-2 years of age. It seems prudent that mothers try to minimize stress during pregnancy and postpartum, though, understandably, this is not always feasible. Additionally, children of mothers who experience a lot of stress during pregnancy or postpartum may benefit from closer surveillance for the development of AD and other atopic diseases.

Additional References

1.         Dayam RM, Law JC, Goetbebuer RL, et al. Accelerated waning of immunity to SARS-CoV-2 mRNA vaccines in patients with immune mediated inflammatory diseases. JCI Insight. 2022 (Apr 26). Doi: 10.1172/jci.insight.159721   Source

2.         Medeiros-Ribeiro AC, Bonfiglioli KR, Domiciano DS, et al. Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis. Ann Rheum Dis. 2022;81:710-719. Doi: 10.1136/annrheumdis-2021-221735 Source

3.         McKenzie C, Silverberg JI. Maternal depression and atopic dermatitis in American children and adolescents. Dermatitis. 2020;31:75-80. Doi: 10.1097/DER.0000000000000548 Source

• Dupilumab is a subcutaneous injection therapy that inhibits the interleukin 4-receptor alpha subunit. It was approved in the United States for the treatment of adults with moderate to severe AD in 2017 and has since been approved for children and adolescents down to 6 years of age. Ungar and colleagues studied the effects of dupilumab on SARS-CoV-2 antibody responses in patients with moderate to severe AD. They previously found that dupilumab was associated with milder COVID-19 illness. In this study, they similarly found that dupilumab was associated with lower immunoglobulin G (IgG) antibody levels to SARS-CoV-2, consistent with less severe COVID-19 illness. Future studies are needed to confirm these results. However, these results reassure that taking dupilumab does not pose any major harms in regard to COVID-19 outcomes.

• My patients with AD ask me on an almost daily basis about whether they should get vaccinated for SARS-CoV-2. I recommended that my patients get vaccinated, based on data from vaccine studies. However, there has been a dearth of data on the efficacy and safety of SARS-CoV-2 specifically in AD patients. Kridin and colleagues performed a population-based cohort study including 77,682 adults with AD, of which 58,582 patients had completed two doses of the BioNTech-Pfizer SARS-CoV-2 mRNA vaccine. They found that patients with AD who received both vs no vaccine doses had significantly lower risk for COVID-19, hospitalization, and mortality. These are the best data to date in support of SARS-CoV-2 vaccination in patients with AD. Of note, there was no significant impact of immunosuppressive drugs on vaccine efficacy against COVID-19. However, previous studies in other immune-mediated disorders suggest that immunosuppressants may lower vaccine immune responses.^1,2 Some authors have advocated for temporarily discontinuing immunosuppressive agents for 1-2 weeks before and after administering SARS-CoV-2 vaccines. Currently, there is insufficient evidence to make strong recommendations.

Numerous in utero and early-life risk factors for AD have been examined over the years. Maternal stress and depression have been considered as potential risk factors for AD in children.

• My research group showed a while back that depression during pregnancy and in the postpartum period was associated with higher likelihood of AD in children.³
• Kawaguchi and colleagues recently analyzed data from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Japan, including 8377 mother-child dyads where the child had not developed AD by the age of 1 year. They found that mothers with vs without psychological distress in both prenatal and postnatal periods or even only in the postnatal period had significantly increased risk of their children developing AD at 1-2 years of age. It seems prudent that mothers try to minimize stress during pregnancy and postpartum, though, understandably, this is not always feasible. Additionally, children of mothers who experience a lot of stress during pregnancy or postpartum may benefit from closer surveillance for the development of AD and other atopic diseases.

Additional References

1.         Dayam RM, Law JC, Goetbebuer RL, et al. Accelerated waning of immunity to SARS-CoV-2 mRNA vaccines in patients with immune mediated inflammatory diseases. JCI Insight. 2022 (Apr 26). Doi: 10.1172/jci.insight.159721   Source

2.         Medeiros-Ribeiro AC, Bonfiglioli KR, Domiciano DS, et al. Distinct impact of DMARD combination and monotherapy in immunogenicity of an inactivated SARS-CoV-2 vaccine in rheumatoid arthritis. Ann Rheum Dis. 2022;81:710-719. Doi: 10.1136/annrheumdis-2021-221735 Source

3.         McKenzie C, Silverberg JI. Maternal depression and atopic dermatitis in American children and adolescents. Dermatitis. 2020;31:75-80. Doi: 10.1097/DER.0000000000000548 Source

The Food and Drug Administration has approved upadacitinib (Rinvoq) as an oral treatment for active ankylosing spondylitis in adults, its manufacturer AbbVie announced April 29.

Upadacitinib, a selective and reversible Janus kinase inhibitor, is the second drug in its class to be FDA approved for ankylosing spondylitis, after tofacitinib (Xeljanz) in December.

Upadacitinib is now indicated for patients with active ankylosing spondylitis (AS) who have had an insufficient response or intolerance with one or more tumor necrosis factor (TNF) blockers. Upadacitinib is already approved by the FDA for adults with active psoriatic arthritis, moderately to severely active rheumatoid arthritis, and moderately to severely active ulcerative colitis who have had an insufficient response or intolerance with one or more TNF inhibitors. It also has been approved for adults and pediatric patients 12 years of age and older with refractory, moderate to severe atopic dermatitis.

The European Medicines Agency gave marketing approval for upadacitinib in adults with active AS in January 2021.

Two main clinical studies form the basis for the FDA’s approval decision. The phase 3 SELECT-AXIS 2 clinical trial involved patients with an inadequate response or intolerance to one or two biologic disease-modifying antirheumatic drugs (bDMARDs). A total of 44.5% patients with AS who were randomly assigned to upadacitinib 15 mg once daily met the primary endpoint of at least 40% improvement in Assessment in Spondyloarthritis International Society response criteria (ASAS 40) at 14 weeks, compared against 18.2% with placebo.

The second study, the phase 2/3 SELECT-AXIS 1 clinical trial, tested upadacitinib in patients who had never taken bDMARDs and had an inadequate response or intolerance to at least two NSAIDs. In this study, significantly more patients randomly assigned to 15 mg upadacitinib achieved ASAS 40 at 14 weeks, compared with placebo (51% vs. 26%).

Patients randomly assigned to upadacitinib also showed significant improvements in signs and symptoms of AS, as well as improvements in physical function and disease activity, compared with placebo, after 14 weeks. The safety profile for patients with AS treated with upadacitinib was similar to that seen in studies of patients with rheumatoid arthritis or psoriatic arthritis. Potential severe side effects include increased risk for death in patients aged 50 years and older with at least one cardiovascular risk factor; increased risk of serious infections, such as tuberculosis; and increased risk of certain cancers, according to the company statement.

Read the complete prescribing information here.

A version of this article first appeared on Medscape.com.

The Food and Drug Administration has approved upadacitinib (Rinvoq) as an oral treatment for active ankylosing spondylitis in adults, its manufacturer AbbVie announced April 29.

Upadacitinib, a selective and reversible Janus kinase inhibitor, is the second drug in its class to be FDA approved for ankylosing spondylitis, after tofacitinib (Xeljanz) in December.

Upadacitinib is now indicated for patients with active ankylosing spondylitis (AS) who have had an insufficient response or intolerance with one or more tumor necrosis factor (TNF) blockers. Upadacitinib is already approved by the FDA for adults with active psoriatic arthritis, moderately to severely active rheumatoid arthritis, and moderately to severely active ulcerative colitis who have had an insufficient response or intolerance with one or more TNF inhibitors. It also has been approved for adults and pediatric patients 12 years of age and older with refractory, moderate to severe atopic dermatitis.

The European Medicines Agency gave marketing approval for upadacitinib in adults with active AS in January 2021.

Two main clinical studies form the basis for the FDA’s approval decision. The phase 3 SELECT-AXIS 2 clinical trial involved patients with an inadequate response or intolerance to one or two biologic disease-modifying antirheumatic drugs (bDMARDs). A total of 44.5% patients with AS who were randomly assigned to upadacitinib 15 mg once daily met the primary endpoint of at least 40% improvement in Assessment in Spondyloarthritis International Society response criteria (ASAS 40) at 14 weeks, compared against 18.2% with placebo.

The second study, the phase 2/3 SELECT-AXIS 1 clinical trial, tested upadacitinib in patients who had never taken bDMARDs and had an inadequate response or intolerance to at least two NSAIDs. In this study, significantly more patients randomly assigned to 15 mg upadacitinib achieved ASAS 40 at 14 weeks, compared with placebo (51% vs. 26%).

Patients randomly assigned to upadacitinib also showed significant improvements in signs and symptoms of AS, as well as improvements in physical function and disease activity, compared with placebo, after 14 weeks. The safety profile for patients with AS treated with upadacitinib was similar to that seen in studies of patients with rheumatoid arthritis or psoriatic arthritis. Potential severe side effects include increased risk for death in patients aged 50 years and older with at least one cardiovascular risk factor; increased risk of serious infections, such as tuberculosis; and increased risk of certain cancers, according to the company statement.

Read the complete prescribing information here.

A version of this article first appeared on Medscape.com.

The Food and Drug Administration has approved upadacitinib (Rinvoq) as an oral treatment for active ankylosing spondylitis in adults, its manufacturer AbbVie announced April 29.

Upadacitinib, a selective and reversible Janus kinase inhibitor, is the second drug in its class to be FDA approved for ankylosing spondylitis, after tofacitinib (Xeljanz) in December.

Upadacitinib is now indicated for patients with active ankylosing spondylitis (AS) who have had an insufficient response or intolerance with one or more tumor necrosis factor (TNF) blockers. Upadacitinib is already approved by the FDA for adults with active psoriatic arthritis, moderately to severely active rheumatoid arthritis, and moderately to severely active ulcerative colitis who have had an insufficient response or intolerance with one or more TNF inhibitors. It also has been approved for adults and pediatric patients 12 years of age and older with refractory, moderate to severe atopic dermatitis.

The European Medicines Agency gave marketing approval for upadacitinib in adults with active AS in January 2021.

Two main clinical studies form the basis for the FDA’s approval decision. The phase 3 SELECT-AXIS 2 clinical trial involved patients with an inadequate response or intolerance to one or two biologic disease-modifying antirheumatic drugs (bDMARDs). A total of 44.5% patients with AS who were randomly assigned to upadacitinib 15 mg once daily met the primary endpoint of at least 40% improvement in Assessment in Spondyloarthritis International Society response criteria (ASAS 40) at 14 weeks, compared against 18.2% with placebo.

The second study, the phase 2/3 SELECT-AXIS 1 clinical trial, tested upadacitinib in patients who had never taken bDMARDs and had an inadequate response or intolerance to at least two NSAIDs. In this study, significantly more patients randomly assigned to 15 mg upadacitinib achieved ASAS 40 at 14 weeks, compared with placebo (51% vs. 26%).

Patients randomly assigned to upadacitinib also showed significant improvements in signs and symptoms of AS, as well as improvements in physical function and disease activity, compared with placebo, after 14 weeks. The safety profile for patients with AS treated with upadacitinib was similar to that seen in studies of patients with rheumatoid arthritis or psoriatic arthritis. Potential severe side effects include increased risk for death in patients aged 50 years and older with at least one cardiovascular risk factor; increased risk of serious infections, such as tuberculosis; and increased risk of certain cancers, according to the company statement.

Read the complete prescribing information here.

A version of this article first appeared on Medscape.com.

Key clinical point: Abrocitinib improved signs of atopic dermatitis (AD) rapidly and consistently in difficult-to-treat or cosmetically important anatomical regions, such as the head and neck area.

Major finding: Eczema Area and Severity Index (EASI) score of the head and neck region improved significantly as early as at 2 weeks with 200 mg abrocitinib (least square mean % change from baseline [Δ] 52.5%) and 100 mg abrocitinib (Δ 47.8%) vs. placebo (0.1%; both P < .0001) and improvements were sustained up to 16 weeks (both P ≤ .0002).

Study details: Findings are from a post hoc analysis of the phase 3 JADE COMPARE study including 837 patients with moderate-to-severe AD who were randomly assigned to receive 16 weeks of treatment with 200 mg abrocitinib, 100 mg abrocitinib, dupilumab, or placebo, all with background topical therapy.

Disclosures: This study was funded by Pfizer Inc. Five authors declared being current/former employees and shareholders of Pfizer and other authors reported ties with various sources, including Pfizer.

Source: Alexis A et al. Rapidity of improvement in signs/symptoms of moderate-to-severe atopic dermatitis by body region with abrocitinib in the phase 3 JADE COMPARE study. Dermatol Ther (Heidelb). 2022;12:771-785 (Mar 17). Doi: 10.1007/s13555-022-00694-1

Key clinical point: Abrocitinib improved signs of atopic dermatitis (AD) rapidly and consistently in difficult-to-treat or cosmetically important anatomical regions, such as the head and neck area.

Major finding: Eczema Area and Severity Index (EASI) score of the head and neck region improved significantly as early as at 2 weeks with 200 mg abrocitinib (least square mean % change from baseline [Δ] 52.5%) and 100 mg abrocitinib (Δ 47.8%) vs. placebo (0.1%; both P < .0001) and improvements were sustained up to 16 weeks (both P ≤ .0002).

Study details: Findings are from a post hoc analysis of the phase 3 JADE COMPARE study including 837 patients with moderate-to-severe AD who were randomly assigned to receive 16 weeks of treatment with 200 mg abrocitinib, 100 mg abrocitinib, dupilumab, or placebo, all with background topical therapy.

Disclosures: This study was funded by Pfizer Inc. Five authors declared being current/former employees and shareholders of Pfizer and other authors reported ties with various sources, including Pfizer.

Source: Alexis A et al. Rapidity of improvement in signs/symptoms of moderate-to-severe atopic dermatitis by body region with abrocitinib in the phase 3 JADE COMPARE study. Dermatol Ther (Heidelb). 2022;12:771-785 (Mar 17). Doi: 10.1007/s13555-022-00694-1

Key clinical point: Abrocitinib improved signs of atopic dermatitis (AD) rapidly and consistently in difficult-to-treat or cosmetically important anatomical regions, such as the head and neck area.

Major finding: Eczema Area and Severity Index (EASI) score of the head and neck region improved significantly as early as at 2 weeks with 200 mg abrocitinib (least square mean % change from baseline [Δ] 52.5%) and 100 mg abrocitinib (Δ 47.8%) vs. placebo (0.1%; both P < .0001) and improvements were sustained up to 16 weeks (both P ≤ .0002).

Study details: Findings are from a post hoc analysis of the phase 3 JADE COMPARE study including 837 patients with moderate-to-severe AD who were randomly assigned to receive 16 weeks of treatment with 200 mg abrocitinib, 100 mg abrocitinib, dupilumab, or placebo, all with background topical therapy.

Disclosures: This study was funded by Pfizer Inc. Five authors declared being current/former employees and shareholders of Pfizer and other authors reported ties with various sources, including Pfizer.

Source: Alexis A et al. Rapidity of improvement in signs/symptoms of moderate-to-severe atopic dermatitis by body region with abrocitinib in the phase 3 JADE COMPARE study. Dermatol Ther (Heidelb). 2022;12:771-785 (Mar 17). Doi: 10.1007/s13555-022-00694-1

Key clinical point: Long-term dupilumab treatment reduced the severity of hand eczema (HE) and enhanced the quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At week 52, 87.1% patients achieved ≥75% improvement in Hand Eczema Severity Index score, 90.3% patients achieved “clear” or “almost clear” endpoint based on the photographic guide, and mean HE-specific Health-related QoL improved by 63.5% (95% CI −71.1% to −55.9%).

Study details: This was a prospective, observational study including 72 adults with moderate-to-severe AD and concomitant HE, of whom 62 patients completed the 52-week dupilumab treatment.

Disclosures: This study was supported by Sanofi and Regeneron Pharmaceuticals. MLA Schuttelaar and MS de Bruin-Welle declared serving as advisors, consultants, speakers, investigators, and advisory board members or receiving grants from several sources, including Regeneron and Sanofi Genzyme.

Source: Voorberg AN et al. The long-term effect of dupilumab on chronic hand eczema in patients with moderate to severe atopic dermatitis – 52 week results from the Dutch BioDay registry. Contact Dermatitis. 2022 (Mar 13). Doi: 10.1111/cod.14104

Key clinical point: Long-term dupilumab treatment reduced the severity of hand eczema (HE) and enhanced the quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At week 52, 87.1% patients achieved ≥75% improvement in Hand Eczema Severity Index score, 90.3% patients achieved “clear” or “almost clear” endpoint based on the photographic guide, and mean HE-specific Health-related QoL improved by 63.5% (95% CI −71.1% to −55.9%).

Study details: This was a prospective, observational study including 72 adults with moderate-to-severe AD and concomitant HE, of whom 62 patients completed the 52-week dupilumab treatment.

Disclosures: This study was supported by Sanofi and Regeneron Pharmaceuticals. MLA Schuttelaar and MS de Bruin-Welle declared serving as advisors, consultants, speakers, investigators, and advisory board members or receiving grants from several sources, including Regeneron and Sanofi Genzyme.

Source: Voorberg AN et al. The long-term effect of dupilumab on chronic hand eczema in patients with moderate to severe atopic dermatitis – 52 week results from the Dutch BioDay registry. Contact Dermatitis. 2022 (Mar 13). Doi: 10.1111/cod.14104

Key clinical point: Long-term dupilumab treatment reduced the severity of hand eczema (HE) and enhanced the quality of life (QoL) in patients with moderate-to-severe atopic dermatitis (AD).

Major finding: At week 52, 87.1% patients achieved ≥75% improvement in Hand Eczema Severity Index score, 90.3% patients achieved “clear” or “almost clear” endpoint based on the photographic guide, and mean HE-specific Health-related QoL improved by 63.5% (95% CI −71.1% to −55.9%).

Study details: This was a prospective, observational study including 72 adults with moderate-to-severe AD and concomitant HE, of whom 62 patients completed the 52-week dupilumab treatment.

Disclosures: This study was supported by Sanofi and Regeneron Pharmaceuticals. MLA Schuttelaar and MS de Bruin-Welle declared serving as advisors, consultants, speakers, investigators, and advisory board members or receiving grants from several sources, including Regeneron and Sanofi Genzyme.

Source: Voorberg AN et al. The long-term effect of dupilumab on chronic hand eczema in patients with moderate to severe atopic dermatitis – 52 week results from the Dutch BioDay registry. Contact Dermatitis. 2022 (Mar 13). Doi: 10.1111/cod.14104

Key clinical point: Under maximum use conditions, ruxolitinib cream was well-tolerated and reduced the severity of atopic dermatitis (AD) in patients with ≥25% body surface area (BSA) involvement.

Major finding: Treatment-emergent adverse events (AE) of mostly mild and moderate intensity and treatment-related AE were reported by 31.7% and 9.8% of patients, respectively. At day 56, 94.6% of patients reported ≥75% improvement in the Eczema Area and Severity Index.

Study details: Findings are from the phase 1 maximum-use trial including 41 patients with AD who had ≥25% BSA involvement and were administered 1.5% ruxolitinib cream twice daily for 28 days. Of these, 37 patients did not experience any safety concerns and continued treatment for an additional 28 days.

Disclosures: This study was funded by Incyte Corporation. Three authors declared being employees and shareholders of Incyte Corporation and other authors reported ties with several sources.

Source: Bissonnette R et al. A maximum-use trial of ruxolitinib cream in adolescents and adults with atopic dermatitis. Am J Clin Dermatol. 2022 (Apr 4). Doi: 10.1007/s40257-022-00690-3

Key clinical point: Under maximum use conditions, ruxolitinib cream was well-tolerated and reduced the severity of atopic dermatitis (AD) in patients with ≥25% body surface area (BSA) involvement.

Major finding: Treatment-emergent adverse events (AE) of mostly mild and moderate intensity and treatment-related AE were reported by 31.7% and 9.8% of patients, respectively. At day 56, 94.6% of patients reported ≥75% improvement in the Eczema Area and Severity Index.

Study details: Findings are from the phase 1 maximum-use trial including 41 patients with AD who had ≥25% BSA involvement and were administered 1.5% ruxolitinib cream twice daily for 28 days. Of these, 37 patients did not experience any safety concerns and continued treatment for an additional 28 days.

Disclosures: This study was funded by Incyte Corporation. Three authors declared being employees and shareholders of Incyte Corporation and other authors reported ties with several sources.

Source: Bissonnette R et al. A maximum-use trial of ruxolitinib cream in adolescents and adults with atopic dermatitis. Am J Clin Dermatol. 2022 (Apr 4). Doi: 10.1007/s40257-022-00690-3

Key clinical point: Under maximum use conditions, ruxolitinib cream was well-tolerated and reduced the severity of atopic dermatitis (AD) in patients with ≥25% body surface area (BSA) involvement.

Major finding: Treatment-emergent adverse events (AE) of mostly mild and moderate intensity and treatment-related AE were reported by 31.7% and 9.8% of patients, respectively. At day 56, 94.6% of patients reported ≥75% improvement in the Eczema Area and Severity Index.

Study details: Findings are from the phase 1 maximum-use trial including 41 patients with AD who had ≥25% BSA involvement and were administered 1.5% ruxolitinib cream twice daily for 28 days. Of these, 37 patients did not experience any safety concerns and continued treatment for an additional 28 days.

Disclosures: This study was funded by Incyte Corporation. Three authors declared being employees and shareholders of Incyte Corporation and other authors reported ties with several sources.

Source: Bissonnette R et al. A maximum-use trial of ruxolitinib cream in adolescents and adults with atopic dermatitis. Am J Clin Dermatol. 2022 (Apr 4). Doi: 10.1007/s40257-022-00690-3

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), baricitinib therapy resulted in rapid and sustained improvement in skin pain leading to an enhanced quality of life (QoL).

Major finding: Skin pain improved as early as by day 1 with 2 mg baricitinib (least square mean % change from baseline [Δ] −4.4%; P = .048) and by day 2 with 1 mg baricitinib (Δ −6.7%; P = .011) vs. placebo, with improvements maintained through week 16 for both baricitinib doses (P ≤ .05) and 70.9% vs. 10.4% of skin pain responders vs. nonresponders experiencing clinically meaningful improvement in QoL (P < .0001).

Study details: Findings are from a post hoc analysis of the phase 3 BREEZE-AD5 study including 440 adults with moderate-to-severe AD and inadequate response to topical therapy who were randomly assigned to receive once-daily 1 mg baricitinib, 2 mg baricitinib, or placebo for 16 weeks.

Disclosures: This study was sponsored by Eli Lilly and Company. Three authors declared being employees and shareholders of Eli Lilly and other authors reported ties with several sources, including Eli Lilly.

Source: Rosmarin D et al. Rapid improvement in skin pain severity and its impact on quality of life in adult patients with moderate-to-severe atopic dermatitis from a double-blind, placebo-controlled baricitinib phase 3 study. J Cutan Med Surg. 2022 (Mar 31). Doi: 10.1177/12034754221088542

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), baricitinib therapy resulted in rapid and sustained improvement in skin pain leading to an enhanced quality of life (QoL).

Major finding: Skin pain improved as early as by day 1 with 2 mg baricitinib (least square mean % change from baseline [Δ] −4.4%; P = .048) and by day 2 with 1 mg baricitinib (Δ −6.7%; P = .011) vs. placebo, with improvements maintained through week 16 for both baricitinib doses (P ≤ .05) and 70.9% vs. 10.4% of skin pain responders vs. nonresponders experiencing clinically meaningful improvement in QoL (P < .0001).

Study details: Findings are from a post hoc analysis of the phase 3 BREEZE-AD5 study including 440 adults with moderate-to-severe AD and inadequate response to topical therapy who were randomly assigned to receive once-daily 1 mg baricitinib, 2 mg baricitinib, or placebo for 16 weeks.

Disclosures: This study was sponsored by Eli Lilly and Company. Three authors declared being employees and shareholders of Eli Lilly and other authors reported ties with several sources, including Eli Lilly.

Source: Rosmarin D et al. Rapid improvement in skin pain severity and its impact on quality of life in adult patients with moderate-to-severe atopic dermatitis from a double-blind, placebo-controlled baricitinib phase 3 study. J Cutan Med Surg. 2022 (Mar 31). Doi: 10.1177/12034754221088542

Key clinical point: In patients with moderate-to-severe atopic dermatitis (AD), baricitinib therapy resulted in rapid and sustained improvement in skin pain leading to an enhanced quality of life (QoL).

Major finding: Skin pain improved as early as by day 1 with 2 mg baricitinib (least square mean % change from baseline [Δ] −4.4%; P = .048) and by day 2 with 1 mg baricitinib (Δ −6.7%; P = .011) vs. placebo, with improvements maintained through week 16 for both baricitinib doses (P ≤ .05) and 70.9% vs. 10.4% of skin pain responders vs. nonresponders experiencing clinically meaningful improvement in QoL (P < .0001).

Study details: Findings are from a post hoc analysis of the phase 3 BREEZE-AD5 study including 440 adults with moderate-to-severe AD and inadequate response to topical therapy who were randomly assigned to receive once-daily 1 mg baricitinib, 2 mg baricitinib, or placebo for 16 weeks.

Disclosures: This study was sponsored by Eli Lilly and Company. Three authors declared being employees and shareholders of Eli Lilly and other authors reported ties with several sources, including Eli Lilly.

Source: Rosmarin D et al. Rapid improvement in skin pain severity and its impact on quality of life in adult patients with moderate-to-severe atopic dermatitis from a double-blind, placebo-controlled baricitinib phase 3 study. J Cutan Med Surg. 2022 (Mar 31). Doi: 10.1177/12034754221088542

Key clinical point: Children born to mothers who had a cumulative exposure to psychological distress in the prenatal and postnatal periods were at an increased risk of developing atopic dermatitis (AD) at 1-2 years of age.

Major finding: Maternal psychological distress vs. no psychological distress in both prenatal and postnatal periods (adjusted relative risk [RR] 1.34; 95% CI 1.20-1.47) and only in the postnatal period (adjusted RR 1.23; 95% CI 1.07-1.39) was significantly associated with an increased risk of developing AD in children at 1-2 years of age.

Study details: This study analyzed maternal psychological distress during early pregnancy and 1 year after delivery in 8377 mother-child pairs, wherein the child had not developed AD by the age of 1 year.

Disclosures: This study was supported by the Ministry of Education, Culture, Sports, Science, and Technology, Japan. K Murakami declared being an editorial board member of BMC Public Health.

Source: Kawaguchi C et al. Cumulative exposure to maternal psychological distress in the prenatal and postnatal periods and atopic dermatitis in children: Findings from the TMM BirThree Cohort Study. BMC Pregnancy Childbirth. 2022;22:242 (Mar 24). Doi: 10.1186/s12884-022-04556-8

Key clinical point: Children born to mothers who had a cumulative exposure to psychological distress in the prenatal and postnatal periods were at an increased risk of developing atopic dermatitis (AD) at 1-2 years of age.

Major finding: Maternal psychological distress vs. no psychological distress in both prenatal and postnatal periods (adjusted relative risk [RR] 1.34; 95% CI 1.20-1.47) and only in the postnatal period (adjusted RR 1.23; 95% CI 1.07-1.39) was significantly associated with an increased risk of developing AD in children at 1-2 years of age.

Study details: This study analyzed maternal psychological distress during early pregnancy and 1 year after delivery in 8377 mother-child pairs, wherein the child had not developed AD by the age of 1 year.

Disclosures: This study was supported by the Ministry of Education, Culture, Sports, Science, and Technology, Japan. K Murakami declared being an editorial board member of BMC Public Health.

Source: Kawaguchi C et al. Cumulative exposure to maternal psychological distress in the prenatal and postnatal periods and atopic dermatitis in children: Findings from the TMM BirThree Cohort Study. BMC Pregnancy Childbirth. 2022;22:242 (Mar 24). Doi: 10.1186/s12884-022-04556-8

Key clinical point: Children born to mothers who had a cumulative exposure to psychological distress in the prenatal and postnatal periods were at an increased risk of developing atopic dermatitis (AD) at 1-2 years of age.

Major finding: Maternal psychological distress vs. no psychological distress in both prenatal and postnatal periods (adjusted relative risk [RR] 1.34; 95% CI 1.20-1.47) and only in the postnatal period (adjusted RR 1.23; 95% CI 1.07-1.39) was significantly associated with an increased risk of developing AD in children at 1-2 years of age.

Study details: This study analyzed maternal psychological distress during early pregnancy and 1 year after delivery in 8377 mother-child pairs, wherein the child had not developed AD by the age of 1 year.

Disclosures: This study was supported by the Ministry of Education, Culture, Sports, Science, and Technology, Japan. K Murakami declared being an editorial board member of BMC Public Health.

Source: Kawaguchi C et al. Cumulative exposure to maternal psychological distress in the prenatal and postnatal periods and atopic dermatitis in children: Findings from the TMM BirThree Cohort Study. BMC Pregnancy Childbirth. 2022;22:242 (Mar 24). Doi: 10.1186/s12884-022-04556-8

Key clinical point: Patients with chronic rhinosinusitis (CRS) were more likely to develop atopic dermatitis (AD), particularly young (<45 years) and middle-aged (45-64 years) patients.

Major finding: The risk of developing AD was significantly higher in patients with vs. without CRS (adjusted hazard ratio [aHR] 1.1952; 95% CI 1.1009-1.2976), especially among young (aHR 1.1491; 95% CI 1.0386-1.2713) and middle-aged (aHR 1.2944; 95% CI 1.1044-1.5171) patients.

Study details: This was a longitudinal cohort study that included 16,668 patients with CRS and 33,336 sociodemographically matched control individuals without CRS who were followed-up for 11 years.

Disclosures: This research was supported by Hallym University Research Fund and the National Research Foundation funded by the Korean government. The authors declared no conflicts of interest.

Source: Son D-S et al. Chronic rhinosinusitis and the increased incidence of atopic dermatitis. Am J Rhinol Allergy. 2022 (Mar 29). Doi: 10.1177/19458924221090050

Key clinical point: Patients with chronic rhinosinusitis (CRS) were more likely to develop atopic dermatitis (AD), particularly young (<45 years) and middle-aged (45-64 years) patients.

Major finding: The risk of developing AD was significantly higher in patients with vs. without CRS (adjusted hazard ratio [aHR] 1.1952; 95% CI 1.1009-1.2976), especially among young (aHR 1.1491; 95% CI 1.0386-1.2713) and middle-aged (aHR 1.2944; 95% CI 1.1044-1.5171) patients.

Study details: This was a longitudinal cohort study that included 16,668 patients with CRS and 33,336 sociodemographically matched control individuals without CRS who were followed-up for 11 years.

Disclosures: This research was supported by Hallym University Research Fund and the National Research Foundation funded by the Korean government. The authors declared no conflicts of interest.

Source: Son D-S et al. Chronic rhinosinusitis and the increased incidence of atopic dermatitis. Am J Rhinol Allergy. 2022 (Mar 29). Doi: 10.1177/19458924221090050

Key clinical point: Patients with chronic rhinosinusitis (CRS) were more likely to develop atopic dermatitis (AD), particularly young (<45 years) and middle-aged (45-64 years) patients.

Major finding: The risk of developing AD was significantly higher in patients with vs. without CRS (adjusted hazard ratio [aHR] 1.1952; 95% CI 1.1009-1.2976), especially among young (aHR 1.1491; 95% CI 1.0386-1.2713) and middle-aged (aHR 1.2944; 95% CI 1.1044-1.5171) patients.

Study details: This was a longitudinal cohort study that included 16,668 patients with CRS and 33,336 sociodemographically matched control individuals without CRS who were followed-up for 11 years.

Disclosures: This research was supported by Hallym University Research Fund and the National Research Foundation funded by the Korean government. The authors declared no conflicts of interest.

Source: Son D-S et al. Chronic rhinosinusitis and the increased incidence of atopic dermatitis. Am J Rhinol Allergy. 2022 (Mar 29). Doi: 10.1177/19458924221090050

Key clinical point: BNT162b2 SARS-CoV-2 mRNA (BioNTech Pfizer) vaccine is highly effective in patients with atopic dermatitis (AD), with no indication for alternate vaccination strategies among patients receiving immunosuppressants.

Major finding: Patients with AD who received both doses of BNT162b2 vaccine vs. those who were not vaccinated had a significantly reduced risk for SARS-CoV-2 infection (adjusted hazard ratio [aHR] 0.20), COVID-19-associated hospitalization (aHR 0.08), and COVID-19-associated mortality (aHR 0.04; all P < .001), with no impact of immunosuppressive drugs on vaccine efficacy against SARS-CoV-2 infection (P = .958).

Study details: This population-based cohort study evaluated 77,682 adults with AD, of which 58,582 patients had completed two doses of BNT162b2 vaccine.

Disclosures: This study did not receive any funding. AD Cohen declared serving as an advisor, investigator, or speaker for several pharmaceutical companies.

Source: Kridin K et al. Determinants and effectiveness of BNT162b2 mRNA vaccination among patients with atopic dermatitis: A population-based study. Am J Clin Dermatol. 2022 (Mar 16). Doi: 10.1007/s40257-022-00672-5

Key clinical point: BNT162b2 SARS-CoV-2 mRNA (BioNTech Pfizer) vaccine is highly effective in patients with atopic dermatitis (AD), with no indication for alternate vaccination strategies among patients receiving immunosuppressants.

Major finding: Patients with AD who received both doses of BNT162b2 vaccine vs. those who were not vaccinated had a significantly reduced risk for SARS-CoV-2 infection (adjusted hazard ratio [aHR] 0.20), COVID-19-associated hospitalization (aHR 0.08), and COVID-19-associated mortality (aHR 0.04; all P < .001), with no impact of immunosuppressive drugs on vaccine efficacy against SARS-CoV-2 infection (P = .958).

Study details: This population-based cohort study evaluated 77,682 adults with AD, of which 58,582 patients had completed two doses of BNT162b2 vaccine.

Disclosures: This study did not receive any funding. AD Cohen declared serving as an advisor, investigator, or speaker for several pharmaceutical companies.

Source: Kridin K et al. Determinants and effectiveness of BNT162b2 mRNA vaccination among patients with atopic dermatitis: A population-based study. Am J Clin Dermatol. 2022 (Mar 16). Doi: 10.1007/s40257-022-00672-5

Key clinical point: BNT162b2 SARS-CoV-2 mRNA (BioNTech Pfizer) vaccine is highly effective in patients with atopic dermatitis (AD), with no indication for alternate vaccination strategies among patients receiving immunosuppressants.

Major finding: Patients with AD who received both doses of BNT162b2 vaccine vs. those who were not vaccinated had a significantly reduced risk for SARS-CoV-2 infection (adjusted hazard ratio [aHR] 0.20), COVID-19-associated hospitalization (aHR 0.08), and COVID-19-associated mortality (aHR 0.04; all P < .001), with no impact of immunosuppressive drugs on vaccine efficacy against SARS-CoV-2 infection (P = .958).

Study details: This population-based cohort study evaluated 77,682 adults with AD, of which 58,582 patients had completed two doses of BNT162b2 vaccine.

Disclosures: This study did not receive any funding. AD Cohen declared serving as an advisor, investigator, or speaker for several pharmaceutical companies.

Source: Kridin K et al. Determinants and effectiveness of BNT162b2 mRNA vaccination among patients with atopic dermatitis: A population-based study. Am J Clin Dermatol. 2022 (Mar 16). Doi: 10.1007/s40257-022-00672-5