Acne treatments have been relatively flat for three decades, clinicians say. It’s time for a blockbuster treatment, Dr. Fernando says. But in acne and other areas of dermatology innovation, “blockbuster” doesn’t necessarily mean a new drug. The focus, she says, is reformulation strategies. Sanofi Pasteur, for example, is looking to develop acne vaccines.
“With acne, the big issue is compliance,” she says. “Companies are making formulations which are patient-friendly, with minimal side effects. So, you have gel formulations, controlled release drugs … once-a-day formulations… and pump dispensers with metered dosage.”
There is a trend toward combination therapies in acne innovation.
“This has been exemplified by Galderma’s Epiduo (adapalene/benzoyl peroxide), which has been met with much success and the current combination drug of choice. The problem … with combination products is the high price, which ultimately affects availability to patients,” Dr. Fernando says.
Another trend with acne medications — which could spread to other areas of dermatology — is pharmaceutical manufacturers’ deliberate expansion into the pediatric population.
“Galderma recently had an FDA (Food and Drug Administration) label expansion for Epiduo to children as young as 9 years old, tapping into a market that was previously unpenetrated,” she says.
The move is part of the company’s lifecycle management strategy, she says, which will increase sales of the brand.
Pediatric derm strides, challenges
In pediatric dermatology, one of the most exciting innovations in recent years has been in the use of propranolol for hemangiomas, according to Amy Paller, M.D., chairwoman, department of dermatology and professor of pediatrics at Northwestern University Feinberg School of Medicine, Chicago, and president of the Women’s Dermatologic Society.
“The use of propranolol is a marvelous example of what happens when clinicians are observant. (Physicians noted) that the hemangiomas melted away in babies who were treated for their cardiac problems with propranolol,” she says. “Propranolol has since been used to treat thousands of babies with hemangiomas worldwide and is now first-line treatment.”
Dr. Paller says pediatric patients have benefited from the discovery that the mammalian target of rapamycin (mTOR) signaling pathway is activated in vascular malformations. Early studies suggest that systemic administration of sirolimus (also called rapamycin), an mTOR inhibitor, may be helpful.
“The next decade will focus attention on new therapeutic interventions for atopic dermatitis. There are promising trials ongoing with a new topical phosphodiesterase 4 inhibitor (PDE4) for adolescents and children,” Dr. Paller says. “Of course we’re all eagerly watching the incredibly exciting results of trials in adults with atopic dermatitis of inhibition of the interleukin (IL)-4 receptor and looking forward to extending these to children, pending continued evidence of safety.”
But innovation, in itself, doesn’t insure patient access to new treatments. One hurdle, according to Dr. Siegel: Most of the new drugs are costly.
“… Which gets into the issue of, is healthcare reform going to pay for these things?” Dr. Siegel says.