Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Systemics for Pediatric Patients: Are We There Yet in 2024?
Description
The discussion on pediatric systemic therapies for conditions like eczema emphasizes that while there have been significant advancements, the field is still evolving in 2024. The focus is on using biologics as first-line treatments when topical therapies are insufficient or when there are concerns about chronic steroid use. Methotrexate remains a common option for children who do not respond to dupilumab, although it has side effects. Recent data indicates dupilumab's efficacy in very young children, with positive outcomes and low safety concerns. New drugs like triloquinumab and lebrikizumab are showing promise, targeting adolescents and effectively reducing itch and skin symptoms. Pediatric dermatology is also examining the impact of systemic therapy on growth and atopic conditions. Long-term safety data is critical, especially for newer therapies such as Janus Kinase (JAK) inhibitors, which show effectiveness but carry boxed warnings. The need for managed expectations regarding side effects and adherence to therapies, alongside ongoing research, is paramount to improving quality of life for pediatric patients with systemic conditions.
View moreConclusions
- Current first-line systemic treatment for moderate to severe atopic dermatitis in children is biologics, particularly dupilumab.
- Topical therapies should be optimized before considering systemic treatments, especially for children with moderate disease.
- Methotrexate remains a stable option for systemic treatment in children, especially for those who do not respond well to dupilumab.
- Increased weight and body mass index have been observed in children treated with dupilumab, but there are concerns about lower height.
- Dupilumab has shown consistent efficacy and safety across various age groups including children as young as six months.
- New biologics like tralokinumab have demonstrated significant effectiveness in treating adolescent atopic dermatitis.
- Joint therapies involving TCS (topical corticosteroids) and biologics show promising results and can aid in improving quality of life metrics.
- Long-term therapies with dupilumab show no new safety issues in pediatric patients, with lower incidence of conjunctivitis compared to adults.
- Careful monitoring of side effects, including potential skin infections and injection site reactions, is necessary when using these therapies.
- Butala, Paller. Ann Allergy Asthma Immunol 2022;128:488
- Proudfoot et al. Br J Dermatol. 2013;169:901-9; Totri et al. J Am Acad Dermatol. 2017; 76:281-5; Sidbury et al. J Am Acad Dermatol. 71:327-49
- Simpson et al. JAMA Derm 2020;156:44
- Pallar et al. JAAD 2020;83:1282
- Blauvelt et al. Am J Clin Dermatol 2022;23:365
- Paller ... Levit. Paediatr Drugs 2021;23:515
- Siegfried ... Paller. Am J Clin Dermatol 2021;23:515
- Paller ... Prescilla. Paediatr Drugs 2023;25:67
- Paller et al. Pediatr Drugs 2024;26:163
- Paller et al. Pediatr Dermatol 2022;39:187
- Paller AS, Flohr C, Cork M, et al. Efficacy and safety of tralokinumab in adolescents with moderate to severe atopic dermatitis: the phase 3 ECZTRA 6 randomized clinical trial. JAMA Dermatol. Published online April 19, 2023. doi:10.1001/jamadermatol.2023.0627
- Guttman-Yassky E et al. JAMA Derm 2020;156:411-420
- Silverberg JI, et al. N Engl J Med 2023;388:1080-1091
- Simpson EL, et al. JAM Derm 2023;159:182-191
- Paller et al. Dermatol Ther 2023;13:1517
- Igarashi et al. BJD 2024;190:20
- Paller et al. JAMA Derm 2023;159:526
- Torello et al. BJD 2023;189:23