Consensus on the Clinical Approach to Moderate-to-Severe Atopic Dermatitis in Spain: A Delphi Survey

Table 4

Results regarding treatment and follow-up of patients with AD.

Item	Consensus (%)	Majority (%)	Discrepancy (%)
Substances that should be avoided
(i) When the prick test is positive for any allergen with suspicion of clinical involvement, avoidance of these allergens as far as possible may be a useful complementary measure	83.8
(ii) Patients with moderate-to-severe AD should follow a diet that does not include foods testing positive in the prick test or prick-prick test and that are clinically relevant for the patient	91.4
Topical and anti-inflammatory treatment
(i) The use of wet wraps increases the effect of topical corticosteroids	90.4
(ii) Proactive “treatment”, for example, application for two times per week in long-term follow-up, can help reduce new flares	85.6
(iii) Proactive “treatment” with application of tacrolimus ointment two times per week can help reduce new flares	91.2
(iv) Simultaneous combination on the same location of topical glucocorticoids and topical calcineurin inhibitors does not seem to be useful		72.4
(v) Based on results of clinical trials of crisaborole, this is not the treatment of choice for severe AD	92.4
Antipruritic treatment
(i) There are no sufficient bibliographic references supporting the general use of first- and second-generation antihistamines for treating pruritus in AD	85.7
(ii) First- and second-generation antihistamines, in general, are not useful for systemic treatment of AD			64.8
Allergen-specific immunotherapy (allergen-SIT)
(i) Allergen-SIT has positive effects in some sensitized patients with AD		76.2
(ii) AD is not a contraindication for the use of immunotherapy in patients with allergic respiratory diseases (allergic rhinoconjunctivitis, allergic bronchial asthma)	92.4
Systemic treatments
(i) With the current immune response modifiers, the therapeutic needs of patients with severe AD are not sufficiently covered	97.6
(ii) In the treatment of severe AD, cyclosporine has an adequate risk-benefit ratio	80.0
(iii)With phototherapy, the therapeutic needs of patients with severe AD are not sufficiently covered	92.8
(iv) In the treatment of severe AD, phototherapy has an adequate risk-benefit ratio			69.5
New systemic treatments
(i) Treatment with biologic drugs should be considered in patients with severe AD not controlled with conventional systemic and topical treatment	93.6
(ii) The objectives of these new biologic drugs should be targeting mainly cytokines involved in Th2 allergic inflammation such as IL-4, IL-5, IL-13, and IL-31	92.0
(iii) Dupilumab has the potential to become the new first-line reference treatment for patients with moderate-to-severe AD who are candidates for systemic treatment (with or without topical treatment)	90.4
(iv) According to results of phase II studies, JAK inhibitors will be a future treatment of AD

AD: atopic dermatitis; SIT: specific immunotherapy; IL: interleukin; JAK : Janus kinase. 60.0% neither agree nor disagree.