Novel systemic medications-especially for treatment of atopic dermatitis-within therapies of the employer?s liability insur- ance association-a basis for discussion

Abstract

Introduction: The guideline-based use of new systemic therapies for occupational eczema that occur on the basis of heredi-tary predispositions, such as atopic der-matitis (AD), must be considered as part of quality assurance regarding the German occupational disease (OD) No. 5101. In the present work, an overview of the scien-tific background of various, novel systemic therapies (biologics and small molecules/ Janus kinase (JAK) inhibitors (jakinibs)) is highlighted.Methodology: Analysis of the available scientific literature with regard to indications for occupational skin diseases and discussion of ethical aspects.Results: The biologics tralokinumab, lebrikizumab and nemolizumab as well as the JAK inhibi-tors baricitinib, upadacitinib, and abroci-tinib are considered. The spectrum of side effects and effects as well as indications are presented.Discussion: In order to be able to frame scientifically founded and criteria -based recommendations for action for the use of biologicals and JAK inhibitors for the therapy of atopic hand eczema, a dedicated consideration of the respective indications as well as the spectrum of effects and side effects is necessary. In the future, there will be a need to carry out further clinical stud-ies, especially randomized controlled trials (RCTs) regarding chronic hand eczema thera-py.Conclusions: Cost coverage for a therapy with biologicals and JAK inhibitors by the statutory accident insurance (GUV) will be reserved for exceptional cases and is linked to special conditions and comprehensive ac-companying preventive measures. For clini-cally severe occupational eczema (which is the prerequisite for systemic therapies) a special GUV procedure (so-called Verfahren Haut) is established which requires to offer the affected individual and in-patient ter-tiary individual prevention (TIP) measure. In TIP, a well-founded occupational derma-tological causality assessment is performed, and by meticulous diagnostics the appropri-ate therapy and prevention options are de-termined and implemented. Thus, in order to guarantee quick decisions on systemic therapy indications and cost coverage in the interest of the insured persons, and sustain-able support by the administration, swiftly offering TIP to severely affected workers is recommended.