Comparing AD Guidelines From Around the World

At the 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema (RAVE) conference in Chicago, Illinois, Robert Sidbury, MD, presented his session, “Hot Topic: Guideline Updates From Around the World.” Sidbury, division chief of dermatology at Seattle Children’s Hospital, professor of pediatrics at the University of Washington School of Medicine, and a co-chair of the American Academy of Dermatology’s (AAD) Atopic Dermatitis Guidelines Committee, discussed the changes in the AAD’s most recent iteration of the atopic dermatitis guidelines and how those compare to other groups such as the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology’s (ACAAI) recently updated joint guidelines.

“Dupilumab was the first systemic FDA-approved treatment for atopic dermatitis that's not prednisone, and it was approved in 2017. Since that time, there have been guidelines from Europe, from the United States, both American Academy of Dermatology and allergy guidelines, Thai guidelines, Japanese guidelines, Taiwanese guidelines, Mexican guidelines. It's an extraordinary amount of coverage of this disease state because of the advent of so many new medications. So my purview in this lecture was to review that landscape and some of the key takeaways, particularly focused on the comparison between the American Academy of Dermatology guidelines and the joint allergy guidelines; 2 allergy groups combined to put together guidelines and used the exact same methodology as the American Academy of Dermatology guidelines, and yet the results were not always identical,” said Sidbury.

According to Sidbury, the reason that there were key differences in the AAD’s guidelines compared to the AAAAI/ACAAI guidelines is that the allergy group had patient representatives and advocates on their committee, which AAD had in the 2014 guidelines but did not have in this most recent update.

“That led to some deviations from a pure assessment of the evidence on certain drugs. So, we use the same system of assessing the evidence, you’d think we’d come up with the same answers, but if you then involve patient perception of risks, patient access to certain medications, and those sorts of things, that can lead to a different recommendation,” said Sidbury.

Additional differences include the groups not agreeing on the benefit of bleach baths for patients with atopic dermatitis, one group recommended the use of systemic agents such as methotrexate and azathioprine and one group said no. With new medications, ruxolitinib has competing recommendations.

Regarding atopic dermatitis as an ever-evolving disease state with new therapeutics, Sidbury is looking forward to the potential approval of lebrikizumab as an IL-13 inhibitor, nemolizumab as an IL-31-related drug, and OX40 inhibitors.

“There's a list of potential things coming down the pike, which I'm really excited to hear about the latest and the greatest updates,” concluded Sidbury.

Reference

1. Sidbury R. Hot topic: Guideline update from around the world. Presented at: 2024 Revolutionizing Alopecia Areata, Vitiligo, and Eczema Conference; June 8-10, 2024; Chicago, IL.