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Remaining Research Gaps and Bright Future in AD


Mona Shahriari, MD, explores potential areas of research that can contribute to continuous improvement in pediatric atopic dermatitis management.

Five experts delve into the multifaceted aspects of pediatric atopic dermatitis (AD) 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, explores potential areas of research that can contribute to continuous improvement in pediatric atopic dermatitis management.

Episode Transcript

Shahriari: I would say any of my patients with mild, moderate, or severe AD would be an excellent candidate in which the itch improvement, as well as the lesion improvement, would be paramount. I think that the one place that this does make it much easier for patients is when I have a patient, oftentimes, I'm giving them 1 topical for the face, 1 topical for the body, 1 topical maybe for the hands, and then you're using this topical twice a day for the next 2 weeks. And after 2 weeks, I'm transitioning you to this nonsteroidal medication, but if your eczema flares, you're going to go back to the original regimen. If you're dealing with adolescents and adults, maybe they can handle that complex regimen, but in the pediatric patient, mom and dad and the family are really involved in this and it can be very complex depending on what else they have going on. So oftentimes, we send them home with these complex regimens, and we're setting them up for failure because they come back and without a doubt, they put that high potency steroid on their face. And guess what it worked great, but now they have some adverse events because of what they did. So I think the place where ruxolitinib really does shine for patients is in simplifying that treatment regimen for patients who have multiple areas of involvement, who want that quick improvement in the itch, but also that substantial improvement in terms of lesions of their AD.
When you look at patient reported outcomes, itch is by far the most significant issue that AD patients struggle with. And that translates to whether you're a pediatric patient, an adolescent, or an adult...everybody. Itch is by far a significant issue. And there are a lot of studies that show whether you have mild, moderate or severe disease, your itch is actually your number one issue that you want to have treated with the lesional improvement being a close second. And when we look at some of the data in terms of our patient reported outcomes, it is the most common one that we see potentially translates to other patient reported outcomes and other signs of the patient experience with a disease. Itch can impact sleep. If you're not sleeping well, you're not productive at work. If you're not sleeping well, you may not be as able to function. You may not be as able to function effectively in a school environment as well. So all these factors kind of play into the overall patient experience with the disease, and I think that's where ruxolitinib shines.
It can really help reduce the itch and improve the sleep and a lot of our patients. There's also data that shows, with respect to skin and pain, that can help. The quality of life of these patients are also improved whether you're looking at pediatric patients, or you're looking at adults, as well as the adolescent patients. And I think one piece that we don't want to forget about is the family impact, because when a child has AD, the whole family has AD. Any regimen that can really help reduce the burden on the child actually reduces the burden on the family as well. So this is another great place this drug comes into play.
I think the most important gap that we currently have is long-term safety studies because our pediatric data is still pretty new. When we look at the safety data actually, it looks comparable to our adults and we have maximal use studies with patients who have up to 35% of their body surface area involved. They use topical ruxolitinib and we didn't see any impacts from a systemic JAK inhibition standpoint, on their hematologic numbers, so I feel pretty confident in the safety data. We have the short-term safety data and kids are not just small adults. So we want to keep in mind that longer term safety data is something we want to obtain. But the other piece is that AD is one of those conditions where maybe topicals alone aren't going to do it for every one of our patients. And for those people who have moderate to severe disease, you may want to add a systemic. What is the safety of combining topical ruxolitinib with a systemic agent, potentially a JAK inhibitor or a targeted biologic? The label states that we should not be combining it. There are some case studies out there saying that the safety is not a concern. I would love to see larger scale prospective studies that really look at that in more detail, so when we're making decisions in the trenches, we can be assured that there's evidence to back up what we're doing.
I think the biggest takeaway now it's a good time to have AD because there's so much innovation happening in the field. We have many medications that are still coming down the pipeline. They're going to be approved over the next 1 to 2 years. But we're also looking at more unique mechanisms. In the past, our goal was to just kind of quiet down the disease. There is potential for disease modification. If we're treating our patients earlier when they're babies, is there a chance we can prevent the progression to moderate to severe disease? Can we prevent the development of certain comorbidities, potentially the atopic march? If we treat earlier, there's a lot of things pushing us toward maybe a cure for AD. We're not ready for primetime yet, but I think the future is bright in this disease state.

Transcript edited for clarity

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