Dr. Heffernan said he includes sarcoidosis, granuloma annulare and necrobiosis lipoidica diabeticorum under the umbrella of granulomatous diseases.
“As we know, you need tumor necrosis factor to make successful granulomas,” he said. “And medications that are highly effective at blocking tumor necrosis factor, or TNF blockers, like adalimumab and infliximab, have been shown in studies and in case reports and case series to be highly effective for the treatment of sarcoidosis, granuloma annulare and necrobiosis lipoidica diabeticorum. It looks like etanercept is not as effective for these diseases.”
There have been scattered case reports on the use of psoriasis biologics for atopic dermatitis, which, according to the literature, have not been terribly effective, Dr. Heffernan said. The hope, he said, is in medications in development that block IL-4 and IL-13. Dupilumab, an anti-IL-4Rα mAb in phase 3 trials, is one example.
“We could, within the year, have this and other drugs in the class marketed for the treatment of moderate to severe atopic dermatitis. And that could be a significant improvement to our therapeutic options as practitioners who care for people with moderate to severe atopic dermatitis. It’s one of those big medical needs in dermatology,” Dr. Heffernan said.
Anti-TNF meds for hidradenitis suppurativa
Anti-TNF medications have been around the longest and have the most developed safety profile among the biologics used in dermatology, according to Dr. Heffernan.
“There’s evidence that strong anti-tumor necrosis factor blockers, specifically the antibodies like infliximab and adalimumab, make a clinical difference in the treatment of patients with hidradenitis suppurativa. Adalimumab (Humira) is in phase 3 trials right now, which are looking at whether adalimumab will be approved for the treatment of hidradenitis,” he said. “So many practitioners in clinical practice regularly use infliximab and adalimumab for the treatment of hidradenitis, currently in an off-label fashion. So, it would be very helpful for us to have an indicated treatment for hidradenitis, which would be the first indicated treatment for the disease.”
There also is a small case series on the use of anti-TNF medications, as well as for the use of ustekinumab, in patients who suffer from pityriasis rubra pilaris.4