Dermatologists treating moderate-to-severe atopic dermatitis patients should not depend on a rescue approach aimed at responding to atopic dermatitis flares. Rather, clinicians should talk with patients about treatment options that could more optimally control symptoms in the long-term, while avoiding sometimes severe adverse events associated with conventional treatments, according to a paper published February 2019 in the Journal of Clinical and Aesthetic Dermatology.
Specifically, today’s dermatologists should consider using the injectable human IgG4 monoclonal antibody, dupilumab. Other monoclonal antibody IL-13 inhibitors, lebrikizumab and tralokinumab, are in the pipeline and could be among the future options for better controlling atopic dermatitis, according to the paper.
“The time has come for clinicians treating [atopic dermatitis] to consider moving from a rescue approach for flares to treating [atopic dermatitis] as a chronic, inflammatory, cutaneous and systemic disorder by using therapies that more selectively suppress the underlying disease pathophysiology, effectively treat eczema and pruritus, mitigate flares and sustain long-term control of the disease,” writes the paper’s author James Q. Del Rosso, D.O., research director of JDR Dermatology Research in Las Vegas.
In the same manner that biologics for psoriasis and psoriatic arthritis have changed the set point for treatment response from partial to complete clearance, physicians and patients are at the precipice of a revolution of new biologics for atopic dermatitis, says Harry Dao, Jr., M.D., assistant professor of dermatology at Baylor College of Medicine, Houston, Texas.
Evolving spectrum of disease management
Conventional oral systemic treatments for atopic dermatitis and biologics might help patients, but treatment—especially long-term treatment—comes at the cost of sometimes serious adverse events.
Cyclosporine, methotrexate, azathioprine and mycophenolate mofetil seem to modulate pathophysiologic pathways that contribute to atopic dermatitis. And, while none are FDA approved for atopic dermatitis treatment, there’s data on each treatment in adults and children with the disease, Dr. Del Rosso writes.
The problem is these treatments tend not to have a good safety profile with long-term use.
“What is definitely known … is that we can avoid the immunosuppression and concomitant increased risk of cancer and infection in those treated with methotrexate, cyclosporine, azathioprine, and mycophenolate mofetil. These traditional immunosuppressive agents non-specifically lower an individual’s immune status and can prove toxic to various organs, especially with long-term use,” says Dr. Dao, who is not an author of the paper.
Dr. Del Rosso is a consultant, speaker, and/or researcher for several companies who market products used in the management of atopic dermatitis or have compounds under development. These include Almirall, Dermira, Galderma, Genentech, LaRoche Posay, Leo Pharma, Loreal, Ortho Dermatologics, Pfizer, Promius, Regeneron, Sanofi-Genzyme, Skinfix, Sonoma, Sun Pharma, and Taro.
Dr. Dao reports no conflicts of interest on this topic.