Investigational drugs for atopic dermatitis

ABSTRACT

Introduction: Many novel medications and herbal medicines have claimed efficacy on atopic dermatitis (AD).

Areas covered: This review covers evidence on efficacy of topical and oral forms of novel and investigational drugs. Topical agents include emollients, phosphodiesterase E4 (PDE4) inhibitors, and topical herbs. There is little evidence that ceramides or natural moisturizing factors provide relief in AD. PDE4 inhibitors have shown promise as an effective topical treatment for mild-to-moderate AD with minimal adverse events, and dupilumab as an effective subcutaneous agent for the treatment of moderate-to-severe AD in adult patients with little adverse effects. However, only preliminary data are available for dupilumab in children with AD. The long-term effects of dupilumab are also not known. Potential new systemic treatments include a number of herbal concoctions.

Expert opinion: Randomized, double-blind placebo-controlled trials (RCTs) have demonstrated topical PDE4 inhibitors are effective and safe in the treatment of both children and adults with AD but further evaluations are needed. RCTs have also shown that subcutaneous dupilumab is an effective and safe agent for the treatment of AD in adults. Long-term effects of these topical and systemic investigational drugs are currently unavailable. Regarding herbal medications, scientific methods are often flawed and objective evidence is lacking.

KEYWORDS:

• Atopic dermatitis
• Chinese medicine
• crisaborole
• dupilumab
• eczema
• herbs
• investigational drugs
• PDE4

Article highlights

• AD is a chronic relapsing dermatitis associated with allergy/atopy.

• PDE4 inhibitors show promise as an effective topical treatment for mild-to-moderate AD with minimal adverse events.

• Preliminary results have shown that dupilumab given subcutaneously is an effective agent for the treatment of AD in adult patients with little adverse effects.

• Standardization and manufacture of proprietary herbal medicine have become possible.

• There is a need for more well-designed, randomized control trials in herbal medicine research for AD.

Investigational drug discovery for AD should include both topical and systemic medicine. Objective scientific documentation of drug efficacy and adverse effects must be carried out.

This box summarizes key points contained in the article.

Declaration of Interest

The principal author declares that he has  been involved in traditional Chinese medicine trials, and received Hong Kong Government Health & Health Service Research Fund (HHSRF: 02030381) and Innovation and Technology Fund (ITF) of Hong Kong (ITS/409/09) in the studying of traditional Chinese medicine for AD.

Additional information

Funding

This paper was not funded.