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November 25, 2019

Omalizumab for Atopic Dermatitis: Overtreatment or Lifesaver?

Author Affiliations
  • 1Center for Healthcare Research in Pediatrics, Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts
JAMA Pediatr. 2020;174(1):15-16. doi:10.1001/jamapediatrics.2019.4509

Atopic dermatitis is a chronic inflammatory skin disease that affects 15% to 20% of children and 1% to 3% of adults worldwide.1 Omalizumab, a medication administered by subcutaneous injection every 2 to 4 weeks, was approved for moderate-to-severe persistent asthma in patients aged 6 years or older by the US Food and Drug Administration in 2003.2 Atopic dermatitis in children is often IgE mediated, and omalizumab is an anti-IgE medication that binds to human IgE and thus limits mast cell degranulation and inhibits the release of inflammatory mediators. Therefore, it makes logical sense that omalizumab could be efficacious in atopic dermatitis treatment.3 In this issue of JAMA Pediatrics, Chan et al4 conducted a 24-week double-blind, placebo-controlled randomized clinical trial to determine if omalizumab is effective in severe childhood atopic dermatitis. Their results suggested improved atopic dermatitis severity, as measured by the SCORAD (Scoring Atopic Dermatitis) index, and improved quality-of-life scores in the omalizumab group compared with the placebo group.4 Although the study by Chan et al4 suggested that omalizumab is efficacious for atopic dermatitis in children, more questions need to be answered before the drug can be used to treat atopic dermatitis in clinical practice. Specifically, this study questions whether omalizumab is cost-effective for atopic dermatitis. Cost-effectiveness analyses can help health care decision-makers choose between new and existing interventions as well as compare costs, benefits, and harms associated with each intervention.5 Although no cost-effectiveness analyses on omalizumab as a treatment for atopic dermatitis have been published to date, thinking through the associated costs, benefits, and harms can add perspective to the Chan et al study.4

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