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Pediatric Potency: Ruxolitinib vs Triamcinolone


Mona Shahriari, MD, expands on benefits of ruxolitinib in managing itch and inflammation in pediatric atopic dermatitis.

Five experts delve into the multifaceted aspects of pediatric atopic dermatitis care including demographic variances to long-term safety and efficacy, comparative analyses, key takeaways from recent research, personalized approaches, and future research directions. Discover clinical insights into the role of ruxolitinib (Opzelura) in addressing critical challenges and enhancing patient outcomes.

In this episode, Mona Shahriari, MD, assistant clinical professor of dermatology at Yale University in New Haven, Connecticut, expands on benefits of ruxolitinib in managing itch and inflammation in pediatric atopic dermatitis.

Episode Transcript

Shahriari: As someone who sees a lot of pediatric patients, I think one of the issues we currently have in the topical treatment landscape is that we've had a lot of topical corticosteroids. Those have been our mainstay and our go-to agents, but they come with limitations. For starters, they are broadly immune suppressive and not targeted. There's limitations on the duration of use. Oftentimes, you can use it for 2 to 4 weeks. And then after that, you're worried about local and systemic adverse events, as well as tachyphylaxis. You do need to take a break from the medication.
Also, the same agent can't be used on different body areas. You might need something a little weaker on the face in the groin, and a something a little bit stronger on the trunk and the arms. In that pediatric population, especially in dealing with the infants who have a high BSA to volume ratio. So you have to be cautious with overusing topical corticosteroids because there's a higher chance of systemic absorption and potentially impacts on the HPA axis in terms of suppression and finally, I see a lot of patients with skin color, and I don't love the topical corticosteroids in those individuals, because you have that tendency to get postinflammatory pigmentary changes as a result of overuse of TCS.
I think what we really need in the space currently is a treatment that can simplify the regimen and also allow for us to deliver better patient care, because when we have a topical corticosteroids, we know we had those limitations. So we had the next generation of our non steroids that hit the space and we thought this was going to be the best thing ever. And from a safety standpoint, it definitely helped address some of the unmet needs that we had in the topical corticosteroid landscapes. However, their efficacy left something to be desired. So what we really need nowadays is an agent that one, simplifies the regimen for our patients, one topical that you could use on any effective area head-to-toe for as long as you need to to effectively treat the disease. But also, we don't want to compromise efficacy when we're giving that agent to our patients. And that's really I think, where topical ruxolitinib helps meet these gaps.
Topical ruxolitinib has many clinical trials currently in the space. We've looked at both adolescent and adult patients with respect to their itch improvement, as well as respect to their to the lesion reduction that they've been having. And one unique thing about this drug is the speed at which it works. We have improvement of the skin lesions within 2 weeks depending on which study that you look at and each improvement in as little as 12 hours or 15 minutes, depending on which study we're looking at. In those same results that we saw in our adolescents and our adults, we were able to see within our pediatric population as well, our age 2 to 11 year olds. But I really think what's different about this medication is we do have an analysis where ruxolitinib goes head-to-head against the mid potency topical corticosteroid triamcinolone. Oftentimes, when we have these non steroidal medications, as we talked about earlier, the efficacy piece is what's missing. The safety piece is definitely there. And when we looked at this head-to-head, it was actually pretty impressive. When it came to the lesional improvement, ruxolitinib rival triumphs alone, and when it came to the itch improvement, actually the patients did a little bit better in terms of how quickly their itch improved and though that was not necessarily the pediatric population we're looking at, a lot of the data does translate over to that younger population. So for me, I'm very excited to be able to pack the punch of a topical corticosteroid with all the safety of a nonsteroidal with ruxolitinib.

Transcript edited for clarity

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