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Information on how to access prescribing information and adverse event reporting can be found at the bottom of the page.Atopic dermatitis

Atopic dermatitis (AD), also known as atopic eczema or eczema, is one of the most common chronic inflammatory skin conditions, affecting people of all ages and genders around the world.1,2 
AD is a chronic, relapsing inflammatory skin disease with a complex pathophysiology that is characterized by skin that is dry and intensely itchy.3-5
The key cytokines IL-4, IL-13, IL-31, TSLP and IL-22 are believed to drive inflammation, itch, and skin-barrier disruption.3,6,7
Signal transmission is via the JAK/STAT pathway.3,6,7

Lorem ipsum dolor sit amet, consectetur adipiscing elit. Curabitur neque tellus, elementum sit amet lectus id, congue varius elit. Fusce molestie urna id elit fermentum tincidunt. Proin vel nibh sed elit commodo efficitur nec nec ipsum. Aliquam erat volutpat. Suspendisse eu elit et nisi malesuada luctus. Phasellus nec velit dapibus, condimentum purus non, rutrum mi. In eros sem, pellentesque id congue mollis, vehicula sit amet neque. Quisque condimentum feugiat quam non rhoncus. Cras eget vestibulum urna. Nullam sodales ipsum elit, ac commodo odio fringilla at.Figure from Cork M, et al. 2020.
Learn more about the involvement of JAK-STAT signalling pathways in atopic dermatitis with this short animation video.Risk factors for atopic dermatitis
  • Genetic8 E.g. family history of atopy, loss-of-function mutations in FLG 
  • Immunological8 E.g. autoimmune disorders, allergies
  • Environmental8 E.g. climate, pollutants


Prognosis in patients with AD is generally favourable9. However, patients with severe, widespread disease and concomitant atopic conditions (e.g. asthma, allergic rhinitis) may experience poorer outcomes.




The pathophysiology of AD is complex, involving a close interplay between the immune system, environmental triggers, barrier defects, and genetic factors.10,11 The immune dysregulation that underlies the disease has been shown to vary across age and racial groups, which may help to explain its variable presentation across populations.12
  • Immune activation patterns of AD lesions are variable among different racial and ethnic groups10
  • For example, Asian AD may take on more of a psoriasiform (rough and scaly) appearance, driven by T helper (Th) cell 1710
  • Differences among AD phenotypes may have important therapeutic implications associated with specific cytokine targeting strategies10


​​​​​​​

AD is associated with multiple comorbitiditesA complex relationship between AD and atopic inflammatory diseases has been observed.13-15
Reduced QoL and psychological aspects may lead to unhealthy habits, such as smoking and a sedentary lifestyle. In turn, these may increase patient morbidity/mortality.16
Figure adapted from Silverberg J, et al. 2019, Kusari A, et al. 2019 and Kage P et al. 2020.Atopic dermatitis and skin colourAtopic dermatitis is associated with physical, social, emotional, and economic challenges but patients with skin of colour may face unique burdens10,18. ​​​​​​​ For one, patients with AD and skin of colour often go underdiagnosed and are also underrepresented in clinical trials. Even so, these patients are more likely to seek out medical care and have an increased cost of care associated with their disease.10, 17

​​​​​​​You can review several of the distinctive challenges experienced by patients with AD and skin of colour below.

Diagnostic considerations10,17
•    Diagnosing erythema in skin of colour is challenging and may delay diagnosis and treatment
•    The use of common AD clinical assessment tools (eg, EASI and SCORAD) that rely on skin erythema may dramatically underestimate AD severity in darker skin types
​​​​​​​
Clinical trial considerations10,17,19
•    Patients with skin of colour are often underrepresented in AD clinical trials, resulting in limited efficacy data on treatment therapies
•    In AD clinical trials conducted between 2000 and 2009, 18% of patients were black and 2% were Hispanic. While African American clinical representation closely approximated their representation in the US population, Hispanics were disproportionately underrepresented. 
​​​​​​​
Socioeconomic considerations20,21
​​​​​​​​​​​​​•    In the United States, patients with skin of colour and AD are more likely to seek out medical care and have an increased cost of case associated with their AD.
•    Black patients had 3x more medical visits and Asian/Pacific Islander patients had 7x more medical visits per capita for AD than white patients.

Cibinqo Discover which patients may be suitable for treatment with Cibinqo.


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CibinqoIntroducing Cibinqo: Discover the benefits that Cibinqo can offer your patients with moderate-to-severe AD. 


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AD=atopic dermatitis; DC=dendritic cell; IFNγ=interferon gamma; IL-17 A/F=IL-17 homodimer or heterodimer; IL=interleukin; ILC=innate lymphoid cell; JAK=Janus kinase; LC=Langerhans cell; S. aureus=Staphylococcus aureus; STAT=signal transducer and activator of transcription; Th=T helper cell; TSLP=thymic stromal lymphopoietin; QoL= Quality of Life

References:
1. Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Primers. 2018;4:1. doi.org/10.1038/s41572-018-0001-z.

2. Silverberg JI. Public health burden and epidemiology of atopic dermatitis. Dermatol Clin. 2017;35:283-289.
3. Kim J, et al. Allergy Asthma Proc. 2019;40(2):84–92.
4. Cork M, et al. J Dermatolog Treat. 2020;31(8):801–809.
5. Laughter MR, et al. Br J Dermatol. 2020;184(2):304–309.
6. Paller AS, et al. J Allergy Clin Immunol. 2017;140(3):633–643.

7. Guttman-Yassky E, et al. Expert Opin Biol Ther. 2013;13(4):549–561
8. Ng YT, Chew FT. World Allergy Organ J. 2020;13(11):100477.
9. Kapur S, et al. Allergy Asthma Clin Immunol. 2018;14(suppl 2):52.
10. Brunner PM, Guttman-Yassky E. Racial differences in atopic dermatitis. Annals of Allergy, Asthma & Immunology. 2019 May 1;122(5):449-55.
11. Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, Berger TG, Bergman JN, Cohen DE, Cooper KD, Cordoro KM. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. Journal of the American Academy of Dermatology. 2014 Feb 1;70(2):338-51.
12. Czarnowicki T, He H, Krueger JG, Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143(1):1-11.
13. Silverberg J. Ann Allergy Asthma Immunol. 2019;123(2):144–151.
14. Kusari A, et al. Dermatol Clin. 2019;37(1):11–20.
15. Kage P et al. JDDG 2021;18(2):93-102.
16. Carrascosa JM, Morillas-Lahuerta V. Actas Dermosifiliogr. 2020;111(6):481–486.
17. Kaufman BP, Guttman‐Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups—variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27(4):340-357.
18. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):345-360.
19. Hirano SA, Murray SB, Harvey VM. Reporting, representation, and subgroup analysis of race and ethnicity in published clinical trials of atopic dermatitis in the United States between 2000 and 2009. Pediatr Dermatol. 2012;29(6):749-755.
20. Janumpally SR, Feldman SR, Gupta AK, Fleischer AB. In the United States, blacks and Asian/Pacific Islanders are more likely than whites to seek medical care for atopic dermatitis. Arch Dermatol. 2002;138(5):634-637.
21. Narla S, Hsu DY, Thyssen JP, Silverberg JI. Predictors of hospitalization, length of stay, and costs of care among adult and paediatric inpatients with atopic dermatitis in the United States. Dermatitis. 2018;29(1):22-31

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PP-CIB-GBR-0130. April 2022
Prescribing information: Cibinqo (abrocitinib) Prescribing Information (Great Britain) – 200mg, 100 mg and 50 mg film-coated tablets

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