Stappenplan systemische therapie

Systemic immuno-modulating drugs that are used in the treatment of severe, difficult to treat AD patients are cyclosporine-A (CsA), azathioprine, mycophenolate mofetil (MMF), mycophenolic acid (MPA), methotrexate (MTX) and oral corticosteroids. CsA is the most extensively studied in severe AD, in both adults and children: CsA is a fast acting drug (efficacy <2 weeks) and the decrease in clinical score varies between 53% tot 95% in the different studies. According to literature there is also evidence for the clinical efficacy of azathioprine, MTX and MMF/MPA in the treatment of severe AD. All three compounds are slow acting drugs (clinical efficacy after 8-12 weeks) and the clinical effect is less than that of CsA. Data on long-term efficacy and safety of systemic immune-modulating drugs in AD are limited. Long-term treatment with CsA can be recommended for up to 1 year based on 4 open studies. For azathioprine, MPA and MTX clinical and safety data in AD are only available until 24-30 weeks of treatment in small groups of patients. From the literature, evidence for treatment of severe AD with oral corticosteroids is very limited. However, oral corticosteroids can be considered as short-term treatment (2-3 weeks) during exacerbations of AD or can be used as co-medication during the first weeks of treatment with a slow acting immune-modulating drug such as azathioprine, MTX or MMF/MPA.