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Review
. 2025 May;15(5):1063-1078.
doi: 10.1007/s13555-025-01391-5. Epub 2025 Mar 31.

Risk Assessment in Atopic Dermatitis: Guidance from a Multidisciplinary Expert Panel

Alessandra Narcisi  1 , Vito Di Lernia  2 , Maria Esposito  3 , Vittorio Forte  4 , Silvia Mariel Ferrucci  5 , Lorenzo Gerratana  6   7 , Pietro Morrone  8 , Saverio Muscoli  9 , Maddalena Napolitano  10 , Michela Ortoncelli  11 , Marina Talamonti  12
Affiliations
Review

Risk Assessment in Atopic Dermatitis: Guidance from a Multidisciplinary Expert Panel

Alessandra Narcisi et al. Dermatol Ther (Heidelb). 2025 May.

Abstract

Guidelines recommend that patients with severe atopic dematitis (AD) be treated with Janus kinase inhibitors (JAKi). Recently, the safety of JAKi as a class was reviewed by the European Medicines Agency, leading to a modification of the Summaries of Product Characteristics. For upadacitinib, changes involve reduced posology and restriction of its use to patients with no other alternative amongst the elderly and those at an increased risk of major adverse cardiovascular events (MACE), cancer and venous thromboembolism (VTE). Risk assessment may be daunting and clarity regarding definitions and data is needed. An interdisciplinary workshop, termed the Multiple In-treatment Risk Assessment & Management, was conceived to provide dermatologists with a platform for multidisciplinary exchange on risk assessment in patients with MACE, cancer and VTE to correctly recognise patients with increased risk. In this review, we characterised common and less common patient profiles in order to assess the risk. With the cooperation of a cardiologist, oncologist, respiratory medicine specialist and haematologists, we identified the risk factors for MACE, cancer and VTE. The results show that taking a careful medical history is the basis of risk assessment and that a careful medical history should be performed regardless of the intended therapy in AD. We propose that risk levels be used in the general population as a benchmark to evaluate risk levels in patients with AD, and provide a checklist to support such risk assessments in routine clinical practice. Our work provides a clear framework for risk assessment to the community of dermatologists and, therefore, contributes to improving the standard of care in AD.

Keywords: Atopic dermatitis; Cancer; JAKi; MACE; Risk assessment; VTE.

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Conflict of interest statement

Declarations. Conflicts of Interest: Alessandra Narcisi acted as investigator, consultant, speaker and/or advisory board member for AbbVie, Eli Lilly, Novartis, UCB, Almirall, Leo Pharma, Pfizer, Sanofi, Janssen. Vito Di Lernia served as consultant and/or member of Data Safety Monitoring Board or advisory boards and/or received speaker honoraria from AbbVie, Amgen, Eli Lilly, Janssen and served as principal investigator for Almirall, Eli Lilly, Janssen, Novartis and Sanofi. Maria Esposito served as speaker/consultant for AbbVie, Amgen, Almirall, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Sanofi, UCB. Vittorio Forte served as speaker/consultant for AbbVie. Silvia Mariel Ferrucci served as a speaker, advisory board member or principal investigator in clinical trials per AbbVie, Amgen, Almirall, Bayer, Galderma, Novartis, Leo Pharma, Eli Lilly, Pfizer. Lorenzo Gerratana held consulting or advisory roles for AstraZeneca, Daiichi Sankyo, Eli Lilly, GlaxoSmithKline, Incyte, Novartis, Pfizer, Merck Sharp & Dohme, Menarini Stemline, AbbVie, Travel Expenses: Menarini Stemline, Novartis. Pietro Morrone served as a speaker/consultant for AbbVie, Almirall, Eli Lilly, Janssen, Leo Pharma, Novartis, Pfizer, Sanofi, UCB. Saverio Muscoli served as a speaker, consultant, and advisory board member for AbbVie, Sanofi, Amgen, Novo Nordisk, Daiichi Sankyo, Astra Zeneca. Maddalena Napolitano acted as investigator, speaker, consultant, and advisory board member for AbbVie, Eli Lilly, Leo Pharma, Pfizer, Almirall, and Sanofi. Michela Ortoncelli received research and travel grants from AbbVie, Sanofi, Lilly, Novartis, Almirall, Leo Pharma. Marina Talamonti served as a speaker, consultant, and advisory board member for AbbVie, Eli Lilly, Janssen, Almirall, Leo Pharma and Sanofi. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Checklist for taking medical history for risk assessment
See this image and copyright information in PMC

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