Using the guidelines in clinical care
According to Dr. Davis, the topic of which agent if any should be considered “first line” generated robust discussion among the work group members.
“When there are not robust head-to-head trials – and there are not – it is often opinion that governs this decision, and opinion should not, when possible, govern a guideline,” Dr. Davis said. “Accordingly, we determined based upon the evidence agents – plural – that deserve to be considered ‘first line’ but not a single agent.”
In her opinion, the top three considerations regarding use of systemic therapy for AD relate to patient selection and shared decision making. One, standard therapy has failed. Two, diagnosis is assured. And three, “steroid phobia should be considered,” and patients should be “fully informed of risks and benefits of both treating and not treating,” she said.
Dr. Sidbury reported that he serves as an advisory board member for Pfizer, a principal investigator for Regeneron, an investigator for Brickell Biotech and Galderma USA, and a consultant for Galderma Global and Micreos. Dr. Davis reported having no relevant disclosures. Other work group members reported having financial disclosures with many pharmaceutical companies. The study was supported by internal funds from the American Academy of Dermatology.