Terapias sistêmicas na dermatite atópica moderada a grave: estudo de vida real em centro terciário de referência
Systemic therapies for moderate-to-severe atopic dermatitis: a real-world study at a tertiary referral center
Fábio Chigres Kuschnir, Juliana dos Santos de Carvalho Oliveira, Angélica Varela Rondon, Natalia Rocha do Amaral Estanislau
Resumo
Introdução: A dermatite atópica (DA) moderada a grave apresenta importante impacto clínico e psicossocial, frequentemente associada a multimorbidades alérgicas e necessidade de terapias sistêmicas. Dados nacionais de vida real comparando diferentes tratamentos sistêmicos em serviços terciários ainda são limitados. Neste contexto, o objetivo principal deste estudo foi avaliar a resposta terapêutica de diferentes terapias sistêmicas utilizadas em pacientes com DA moderada a grave acompanhados em ambulatório terciário universitário do Sistema Único de Saúde (SUS). Métodos: Estudo observacional retrospectivo longitudinal baseado em revisão de prontuários de pacientes acompanhados entre 2016 e 2025. Foram analisadas variáveis clínicas, terapêuticas e a evolução dos escores Scoring Atopic Dermatitis (SCORAD), Atopic Dermatitis Control Tool (ADCT) e Dermatology Life Quality Index (DLQI) e Children’s Dermatology Life Quality Index (cDLQI) nos momentos basal, 8 e 16 semanas. Utilizouse análise de variância para medidas repetidas. Resultados: Foram incluídos 45 pacientes, predominantemente do sexo feminino (60,0%), com média de idade de 17 ± 11,5 anos e início da doença na infância (< 5 anos) em 60,0% dos casos.Multimorbidades atópicas estiveram presentes em 62,2% da amostra, e 75,6% apresentaram sensibilização a aeroalérgenos. O metotrexato foi a terapia sistêmica inicial mais utilizada (44,4%), seguido por dupilumabe (33,3%) e ciclosporina (17,8%). A maioria dos pacientes (73,3%) não apresentou eventos adversos relevantes. Observou-se redução significativa do SCORAD, de 52,9 ± 17,4 no basal para 27,7 ± 16,8 na 16ª semana (p<0,001), com melhora do controle clínico (ADCT; p=0,001) e da qualidade de vida (QoL; p=0,009). Não houve diferenças estatisticamente significativas entre os diferentes esquemas terapêuticos. Pacientes que utilizaram múltiplas terapias sistêmicas apresentaram maior gravidade residual ao final do acompanhamento (p<0,001). Conclusões: As terapias sistêmicas demonstraram efetividade e perfil de segurança favorável no curto prazo em pacientes com DA moderada a grave acompanhados em ambulatório terciário do SUS. Estudos de vida real podem contribuir para orientar estratégias terapêuticas em cenários de acesso heterogêneo às terapias-alvo.
Palavras-chave
Abstract
Introduction: Moderate-to-severe atopic dermatitis (AD) is associated with substantial clinical and psychosocial burden and frequently requires systemic therapy. National real-world data comparing different systemic treatments in tertiary care settings remain limited. In this context, the primary objective of this study was to evaluate the therapeutic response to different systemic therapies used in patients with moderateto-severe AD followed at a tertiary university outpatient clinic within the Brazilian Unified Health System (SUS). Methods: This retrospective longitudinal observational study was based on the review of medical records from patients followed between 2016 and 2025. Clinical and therapeutic variables, as well as the evolution of Scoring Atopic Dermatitis (SCORAD), Atopic Dermatitis Control Tool (ADCT), and Dermatology Life Quality Index (DLQI) and Children’s Dermatology Life Quality Index (cDLQI) scores at baseline, 8 weeks, and 16 weeks, were analyzed. Repeated-measures analysis of variance was performed. Results: A total of 45 patients were included, predominantly female (60.0%), with a mean age of 17 ± 11.5 years and disease onset in childhood (<5 years) in 60.0% of cases. Atopic multimorbidities were present in 62.2% of the sample, and 75.6% showed sensitization to aeroallergens. Methotrexate was the most frequently prescribed initial systemic therapy (44.4%), followed by dupilumab (33.3%) and cyclosporine (17.8%). Most patients (73.3%) did not present relevant adverse events. SCORAD significantly decreased from 52.9 ± 17.4 at baseline to 27.7 ± 16.8 at week 16 (p < 0.001), with improvement in disease control (ADCT; p=0.001) and quality of life (QoL; p=0.009). No statistically significant differences were observed among the different therapeutic regimens. Patients requiring multiple systemic therapies presented greater residual disease severity at the end of follow-up (p < 0.001). Conclusions: Systemic therapies demonstrated effectiveness and a favorable short-term safety profile in patients with moderate-to-severe AD followed at a tertiary outpatient clinic within the SUS. Real-world studies may contribute to guiding therapeutic strategies in settings with heterogeneous access to targeted therapies.
Keywords
Referências
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Submetido em:
27/05/2026
Aceito em:
29/07/2026
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