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Raj Chovatiya, MD, PhD, Discusses All Things Inflammatory Diseases at AAD 2023

Article

With the recent therapeutic revolution, there has never been a better time to find the right treatment option for your patient suffering from inflammatory diseases.

As a session director and presenter at the American Academy of Dermatology (AAD) Annual Meeting in New Orleans, Louisiana, Raj Chovatiya, MD, PhD, FAAD, assistant professor of dermatology, director of the Center for Eczema and Itch, and medical director of the Clinical Trials Unit at Northwestern University Feinberg School of Medicine, in Chicago, Illinois, as well as a Dermatology Times® Editorial Advisory Board member, discussed need-to-know updates on inflammatory diseases such as atopic dermatitis and alopecia areata.

In his first session, “JAK Inhibitors for Atopic Dermatitis,” Chovatiya described JAK inhibitors as “the next big frontier for dermatologic therapy.” Chovatiya spoke alongside Brittany Gareth Craiglow, MD, FAAD; William Damsky, MD, PhD, FAAD; Alisa Femia, MD, FAAD; Amit G. Pandya, MD, FAAD; April W. Armstrong, MD, MPH, FAAD; and Aaron Mangold, MD, FAAD, in the overarching session “JAK Inhibitors: A New Frontier in Dermatology,” directed by Brett Andrew King, MD, PhD, FAAD.

Chovatiya’s second session at AAD, “Efficacy and Safety of Baricitinib for Inflammatory Disease,” took a deep dive into understanding the need for treatment in alopecia areata and what data is available. Fellow speakers Kenneth B. Gordon, MD, FAAD; Alexandra Boer Kimball, MD, MPH, FAAD; Megan H. Noe, MD, MPH, FAAD; and Bruce Elliot Strober, MD, PhD, FAAD, also spoke in the larger session, “Controversies in JAK/STAT/TYK2 Inhibitors and Establishing Causation in Serious Adverse Effects (SAE) for Drugs and Vaccines,” directed by Stephen E. Wolverton, MD, FAAD.

Lastly, Chovatiya directed a brand-new session, “Itch Tales: Looking Beyond Atopic Dermatitis,” where he also discussed the challenges of diagnosing atopic dermatitis, as many other disease states can present similarly to atopic dermatitis. Other speakers from the new session included Joaquin C. Brieva, MD, FAAD; Joan Guitart, MD, FAAD; George Han, MD, PhD, FAAD; Peter A. Lio, MD, FAAD; Theodore Rosen, MD, FAAD; Elizabeth A. Swanson, MD, FAAD; and JiaDe Yu, MD, FAAD.

Transcript

Raj Chovatiya, MD, PhD, FAAD: Hi there, my name is Dr. Raj Chovatiya. I'm an assistant professor of dermatology, director of the Center for Eczema and Itch, and medical director of the Clinical Trials Unit at the Northwestern University Feinberg School of Medicine in Chicago, Illinois. I'm also an Editorial Advisory Board member for Dermatology Times.

Dermatology Times: What are a few key highlights from your session, “JAK Inhibitors for Atopic Dermatitis?”

Chovatiya: So this was kind of a powerhouse of several hours really talking about JAK inhibitors as the next big frontier for dermatologic therapy, and I was privileged enough to have a chance to chat about all that's been happening with JAK inhibitors and atopic dermatitis. So unless you've been living under a rock or not reading your Dermatology Times, you couldn't have missed the fact that there is now a topical JAK inhibitor and 2 oral JAK inhibitors that are all approved for individuals with atopic dermatitis. All this flurry of activity really happened in late 2021 and early 2022. But there has been just immense amounts of data and changes over the past year. And so really, what my talk focused on was number one, making the case for why we need more therapies for atopic dermatitis and what exactly is missing in terms of topicals that people want to use that are non-steroidal that are targeted, but also oral therapies that are quick, effective, safe, and really allow people to have a deeper improvement of their atopic dermatitis. I then had a chance to really delve deeper into some of the data for each of the drugs. And so obviously, I had a chance to cover a lot of the first line, top line data that you may be familiar with, and the safety as well. But over the past year, there's been a lot of fun updates. So in the case of abrocitinib, an oral medication, we had an approval down to 12 years of age. So I've had a chance to cover some of the adolescent data, but also talk about some of the cool improvement we see across different subsets of patients who have varying combinations of itch, lesional severity, and demographic factors as well. In the case of upadacitinib, our other oral JAK inhibitor, also approved down to 12 years of age, I had a really nice chance to talk about some of the nice long term safety data that's been coming out that have really allowed us to feel confident about this therapeutic class, really insights that I think can be applied to all these medications, and some very interesting data about how to incorporate patient reported outcomes, specifically when thinking about some of the benchmarks for improvement of its disease. Finally, in the case of topical ruxolitinib, the topical JAK inhibitor that we have for atopic dermatitis, I had a chance to delve into what you may not have heard about lately, really some of the deeper insights into itch where we can really see that most people have some type of improvement in their itch. And it happens very, very quickly, which is unlike many of the topicals that we've had a chance to use before.

Dermatology Times: As director of the “Itch Tales,” what highlights did you cover in “The Challenges of Diagnosing Atopic Dermatitis?”

Chovatiya: This was a new session for this year. And it was really a joy to put together because I think that we oftentimes get trapped in this idea that if it's red, if it's itchy, it's a rash, it's atopic dermatitis, and why wouldn't we? We've had the biggest therapeutic revolution in recent time for this disease state, with so many options, so you almost want it to be atopic dermatitis so you can actually get one of these really cool and effective medications approved for your patient. But the thing is, there's a lot of things that can be red, that can be itchy, that can look like atopic dermatitis, but may not be, and those would not be the circumstances in which you would want to use some of these treatments. So really, in my part of this overall session, I just wanted to orient individuals to how heterogeneous the disease of atopic dermatitis is, how differently it can look for morphology to actual location on the body, symptomatic burdens, severity, comorbidities, quality life issues, and then really focusing in on that physical exam part of things about how there's so many things that may look eczematous in appearance, but really are worth additional investigation. Throughout the remainder of the session, we had a chance to delve into some of those major categories. So this includes things like cutaneous lymphoma, immuno bullous diseases that may not present with blistering like pemphigoid, nutritional dermatoses, diaper dermatitis, genodermatoses, allergic contact dermatitis, and even infections and infestations: all things you want to keep in mind when you're taking that itch tail journey of trying to figure out what's going on with your patient.

Dermatology Times: What are a few key pearls from your session, “Efficacy and Safety of Baricitinib for Inflammatory Diseases?”

Chovatiya: This was a fun one because it was an entire session devoted to some of the controversies and safety concerns we have across a lot of different therapies. And of course, JAK inhibitors were included here, and I had the privilege of taking a deep dive into baricitinib. So for us, baricitinib in dermatology is available for the treatment of alopecia areata, a treatment and disease that really was just never available to us until somewhat recently. So the first section of my talk was really designed to understanding the need for treatment in alopecia areata, uncovering some of the data from the actual phase 3 trials that looked at baricitinib, and then taking a look at some deeper insights into efficacy and safety as it relates to disease state. Some of the fun stuff I got to do in the second half of this talk was taking a deeper dive into what we know about the safety of baricitinib, because for those of you that may not realize it, baricitinib actually had a life before alopecia areata. So originally, it was approved for rheumatoid arthritis and has approval in that disease state. There's also a huge clinical trial program for atopic dermatitis. It's actually used quite extensively outside of the US for atopic dermatitis. Probably not going to be going forward with approval here in the US for a variety of reasons, but there's a lot of safety data there. Additionally, studies in more autoimmune connective tissue diseases as well that have its own safety too. So we really got a chance to delve deeply and understand for when we use this medication in alopecia areata, what do we need to be concerned about? And how is this different than what we've seen with this particular drug across all these different inflammatory disease states?

[Transcript edited for clarity]

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