Biologic therapy in the treatment of allergic skin disorders

Kronične, alergijske kožne bolesti pogađaju velik broj ljudi diljem svijeta i često su refraktorne na prve linije liječenja. Postupnim otkrivanjem imunoloških mehanizama uključenih u patogenezu ovih bolesti, dolazi do stvaranja novih, ciljanih lijekova. Biološki lijekovi imaju važnu ulogu u liječenju kroničnih, kožnih bolesti poput kronične urtikarije i atopijskog dermatitisa. Atopijski dermatitis (AD) kronična je upalna bolest kože recidivirajućeg tijeka i složene etiopatogeneze. Pogađa djecu i odrasle, no češće se javlja u djece i čini najčešću upalnu, kožnu bolest dječje dobi Liječenje AD-a uključuje brojne terapijske opcije koje se individualno određuju. Pacijenti s težim oblicima bolesti čine kandidate za liječenje biološkim lijekovima. Dupilumab je prvi biološki lijek odobren za liječenje srednje-teških i teških oblika AD-a, a od nedavno je odobren i JAK inhibitor baricitinib. Kronična urtikarija(CU) bolest je koja otežava svakodnevicu oboljelih i ponekad ne odgovara dobro na liječenje. Omalizumab, humanizirano monoklonalno anti-IgE antitijelo, biološki je lijek indiciran u pacijenata s teškim oblicima kronične spontane urtikarije (CSU) refraktornim na povišene četverostruke doze antihistaminika. Vrlo je učinkovit i siguran lijek. Ligelizumab, visoko-afinitetno, humanizirano, monoklonalno anti-IgE antitijelo, drugi je biološki lijek namijenjen liječenju CU koji je pokazao dobre rezultate u kliničkim istraživanjima. Brojni se biološki lijekovi trenutno ispituju u kliničkim istraživanjima sa svrhom buduće primjene u liječenju AD-a i CU-e. Vrlo je vjerojatno da će se uporaba bioloških lijekova u pacijenata s imunološki-posredovanim, kroničnim, dermatološkim bolestima doprinijeti učinkovitoj kontroli bolesti.Chronic, allergic skin diseases affect great number of patients throughout the world and they are often refractory to first line treatment. As immunologic pathways involved in the pathogenesis of these diseases are being discovered, therapeutic agents targeting specific molecular pathways are being developed. Several biologic agents play important therapeutic roles for management of patients with chronic skin conditions such as chronic urticaria and atopic dermatitis. Atopic dermatitis (AD) is a chronic, inflammatory skin disease with a relapsing course and a complex etiopathogenesis. It affects both adults and children, but it occurs more frequently in children and it is the most common childhood inflammatory skin condition. The treatment of AD includes several therapeutic options. Patients with severe disease may benefit from novel third line therapy agents – biologics. Dupilumab was the first biologic drug approved to treat moderate to severe forms of AD and the second drug approved for the treatment of atopic dermatitis was Jak inhibitor baricitinib. Chronic urticaria (CU) is a very disabling condition, and it may be difficult to treat. Recently, the recombinant humanized monoclonal anti-IgE antibody, omalizumab, has become established as a third line treatment option for people with severe CU inadequately responsive to the above first line treatments. Its efficacy and excellent safety profile make it attractive. Another biologic drug, ligelizumab, a new high affinity humanized, monoclonal anti-IgE antibody, has also shown good results in clinical trials. Several biologic agents are currently under investigation in clinical trials and will possibly play an important therapeutic role for management of patients with CU and AD. It is likely that the therapeutic utility of biologic agents for patients with chronic, allergic, dermatologic disorders will expand in the future