Crisaborole 2% Ointment (Eucrisa) for Atopic Dermatitis

Taylor Evart Woo, MSc; Paul Kuzel, MD, FRCPC

Disclosures

Skin Therapy Letter. 2019;24(2):4-6. 

In This Article

Abstract and Introduction

Abstract

Atopic dermatitis is a common cutaneous disease with significant morbidity affecting children and adults. The mainstay of atopic dermatitis therapy has typically included emollients, topical corticosteroids, and topical calcineurin inhibitors. Among the newer advances recently introduced is crisaborole (Eucrisa™), a phosphodiesterase type-4 inhibitor (PDE-4) for the treatment of mild moderate atopic dermatitis. Evidence from phase 3 trials demonstrates crisaborole as an efficacious topical agent with a favorable safety profile and limited systemic exposure. While the efficacy of crisaborole compared to existing therapies remains unknown, crisaborole is a promising candidate in the treatment of atopic dermatitis.

Introduction

Atopic dermatitis (AD) is a chronic inflammatory cutaneous condition associated with significant morbidity and stigma in affected patients.[1] AD is characterized by the sudden onset of a recurrent, pruritic, erythematous and fissured dermatoses. It is estimated to affect up to 15–30% of children and up to 10% of adults living in industrialized countries.[2] In the United States alone, AD imposes a considerable economic burden, with an estimated cost of up to $3.8 billion annually.[1,3] Clinical features differ with age. The flexural surfaces of upper and lower extremities and face are most often affected during childhood, whereas hands and feet are more commonly involved in adult patients.[4] AD can be associated with serious comorbidities including allergic rhinitis, asthma, hay fever, urticaria and asthma.[3,5] Patients with genodermatoses, such as Wiskott-Aldrich syndrome, may show an AD like skin condition.[6] Individuals with AD are more prone to cutaneous secondary infections by pathogens including Staphylococcus aureus, which is also a leading cause of soft-tissue infections. Moreover, secondary skin infection can lead to exacerbation of AD disease severity.[7]

As the frequency of AD continues to rise, renewed focused on treatment and management is increasingly important.[1] As no curative options exist, therapy centers on controlling disease progression, reducing flares and providing relief from symptoms, including pain and pruritus.[8,9] The mainstays of such therapies include the use of emollients, cosmeceuticals, topical and systemic corticosteroids, as well as topical calcineurin inhibitors (TCIs).[2] Treatment options are predicated on age and AD severity. For instance, mild to moderate AD may be treated with TCIs or corticosteroids such as desonide 0.05% or fluocinolone 0.01%.[8] In patients with moderate to severe AD who are recalcitrant to topical therapy, systemic treatment may include dupilumab administered at 300 mg subcutaneously once weekly or every other week for adults.[10,11] Proactive therapy with tacrolimus 0.1% ointment or pimecrolimus 2% twice daily[9] may be employed to prevent relapses and extend periods without recurrence in patients who experience frequent exacerbations. TCIs have been issued a black box warning based on theoretical concerns that their use may be linked to lymphoma,[12] however, long-term surveillance has not substantiated this risk. Moreover, prolonged use of topical corticosteroids has been associated with cutaneous atrophy, telangiectasia, and striae formation.[8] This has led to the development of new therapies, particularly aimed at the pediatric population. Crisaborole (formerly known as AN2728) is a novel, boron-based phosphodiesterase-4 (PDE-4) inhibitor developed to treat this populace.[8,13]

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