Management of Moderate‐to‐Severe Atopic Dermatitis With Systemic Medications: Review and Expert Commentary

Background The systemic treatment of moderate‐to‐severe atopic dermatitis (AD) in adults has evolved significantly over the past decade in terms of treatment goals and therapeutic options. While many therapeutic options are endorsed by existing guidelines, newer therapies have been held to higher standards of efficacy and safety in clinical trials compared to “traditional” immunosuppressants used in AD. The robust evidence demonstrating the improved benefit‐to‐risk profiles of these newer medications implies that they should be prioritized, as they are more likely to enable patients to achieve modern treatment goals with less risk of adverse events. Objectives To develop an evidence‐based algorithm for the systemic treatment of moderate‐to‐severe AD in adults, with a focus on the Canadian context, and prioritizing strength of evidence and safety over other factors such as cost and reimbursement. Methods An expert panel of 6 Canadian dermatologists with expertise in AD identified randomized clinical trials and publications from prospective registries reporting on ≥ 100 adults taking systemic treatment for AD. The evidence supporting the various therapeutic options was summarized, evaluated, and synthesized into a draft evidence‐based algorithm for the systemic treatment of moderate‐to‐severe AD. Results and Implications The evidence summaries were reviewed and discussed to create a new therapeutic algorithm, which was then refined through iterative review by all authors. This algorithm can provide evidence‐based support for decision‐making in the systemic treatment of moderate‐to‐severe AD in Canada and beyond.