June 2019

Professor Carsten Flohr is Chair in Dermatology and Population Health Science at St John’s Institute of Dermatology, King’s College London. He is also a Consultant Dermatologist at Guy’s & St Thomas’ NHS Foundation Trust.

In 2017, Professor Flohr and colleagues from 17 other UK academic and NHS institutions as well as patient organisations were awarded a strategic grant from the British Skin Foundation to set up the UK-Irish Atopic eczema Systemic TherApy Register (A-STAR).

Here Professor Flohr explains in more detail about his research and what he hopes it can achieve.

Background:

The prevalence of eczema (also called ‘atopic eczema’) has increased three-fold during the last century, affecting around 20% of children and 8% of adults in the UK. Eczema has a profound impact on patients’ quality of life, mainly through recurrent skin infections, itching and resulting sleep disturbance. There is also a strong link with food and respiratory allergies, anxiety and depression. While most children and adults with mild-to-moderate eczema can be treated efficiently with emollients and topical anti-inflammatory creams, those with severe disease often require so-called systemic immuno-modulatory treatment, either with conventional immuno-suppressive medication or novel therapies, such as the biologic dupilumab. Dupilumab targets specific pathways in eczematous skin (IL-4 and IL-13 pathway) and is now approved by the UK National Institute for Health and Care Excellence (NICE) in adolescents and adults for NHS care.

However, the current evidence for such treatments stems from a small body of randomised controlled trials (RCTs), and there are no long-term, comparative and ‘real world’ data on the effectiveness and safety of these treatments from a large-scale multi-centre cohort study (register).

The establishment of such a register was consequently highlighted as a key research priority for eczema research by a Delphi exercise conducted by the UK Translational Research Network in Dermatology (UK TREND). In addition, several recent treatment guidelines and a systematic review have highlighted these gaps and lamented the resulting lack of clear management guidance to inform clinical practice.

The A-STAR register is therefore of vital importance to evaluate the ‘real world’ use of systemic immuno-modulatory therapies in paediatric and adult patients to provide effectiveness and drug adverse event data beyond the confines of short-term RCTs. Such a cohort will ultimately inform treatment guidelines and act as a resource for biomarker discovery and pharmacogenetic and pharmacodynamic research. With novel biologic therapies entering our clinical practice, the timing for this project could not be better.

Research interests of my department:

I direct the Unit for Population-Based Dermatology Research at John’s Institute of Dermatology at King’s College London. We conduct translational and clinical research into the prevention and treatment of skin and allergic diseases, in particular atopic eczema and food allergies. For instance, I am the Dermatology Lead Investigator on the Enquiring About Tolerance (EAT) Study, which showed that introducing foods that can cause allergies from three months of life alongside breastfeeding reduces the risk of food allergy development compared to exclusive breastfeeding for six months. In addition to being Chief Investigator of the A-STAR register, I also lead an international trial funded by the National Institute of Health Research (NIHR) Efficacy and Mechanism Evaluation (EME) Programme, which compares the treatment efficacy, safety and cost-effectiveness of cyclosporine with methotrexate in children and young adults with severe eczema (TREAT trial). Furthermore, we work with the pharmaceutical industry on a number of novel systemic treatments for severe eczema in children and young adults. We also have a research programme that examines the role of pathogenic and non-pathogenic bacteria in eczema. This work is taken forward as part of the BIOMAP consortium, a large research collaboration funded by the EU that focuses on the causes of eczema to develop more individualised care for patients.

Professor Carsten Flohr, King’s College London

Eczema