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The Crystal Ball: What This Means for the Future of Atopic Dermatitis Treatments

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Peter Lio, MD, reflects on current unmet needs in atopic dermatitis and suggests directions for future research and development.

Peter Lio, MD: Hello, and welcome to the final entry in this Dermatology Times Partner Perspectives video series sponsored by ASLAN Pharmaceuticals. The content was developed for, directed by, and presented on behalf of ASLAN Pharmaceuticals. I'm Dr. Peter Lio and I'm a clinical assistant professor of dermatology and pediatrics at Northwestern University, Feinberg School of Medicine. I'm also the founding director of the Chicago Integrative Eczema Center and a founding partner at Medical Dermatology Associates of Chicago.

In the previous 2 videos, I talked about qualitative and quantitative data, highlighting patient perspectives and attitudes toward atopic dermatitis treatments. In this video, we're going to revisit some key findings and discuss important takeaways for future inquiry and development of atopic dermatitis therapies.

To some degree, a good clinician is very in tune with their patient population, but at the end of the day, you really have to go to the horse's mouth proverbially. You actually have to ask the patients what their experience is and what they want. I love the idea that these surveys are not just asking them general questions, qualitatively. We're doing that, but we're also seeing a quantitative aspect. I really believe this is the only way we can further refine things. We can obviously keep bringing new treatments, but then we have to get feedback to see what could we do better. I think this really captures that approach to finding and refining what is known and what the patient experience is.

I think it's abundantly clear that itch is a real priority for patients. In fact, it seems to be perhaps the most important of all, getting to the root of that itch. We also understand that the way that a medication is administered is really important. Frequency, the dosing frequency, matters. I think that we saw there's willingness to do a trade-off for efficacy, but that convenience, that ability to do it more easily and fit it into their life, is a real factor and can shape our ability to get patients better.

I think in the past couple of years, we've finally gotten some new options for patients after a very long drought where we had almost nothing really to offer them. With this, we're beginning to see some of the pitfalls, some of the problems, some of the limitations of the currently available medications. I talk to patients every day. In fact, my practice is really focused on patients who have tried everything and are frustrated or stuck. I am in particular constantly looking for new solutions and new possibilities because I literally meet patients who say, “this maybe helped me a little bit or helped me initially, but here's why I couldn't go further.” It could be for many different reasons. Part of what we're doing when we look at this is we can see what kinds of problems come up. Maybe they're not enough to stop the use of a current treatment, but that would be enticing enough to switch to a new one. I think that's really exciting, again, to be able to polish and refine our options so that a patient could have something that is a better fit into their life and that better meets their needs.

I think most patients are initially a little bit nervous when we talk about an injectable medication, but what I find is that almost all of them, and in my own experience, essentially every patient that I think is a good candidate for an injectable agent, we're able to get them over the hump, whether it's fear, whether it's concern about the handling of the medicine. We almost always can get them there. Sometimes it requires a team approach. Once we're getting them on that medication, sometimes life gets in the way, and I've heard that many times: “Can I use it less frequently?” Now, we know that one of the existing biologics actually does have an FDA indication for spacing out to monthly dosing, but that's really only after about 16 weeks, and if the patient is under good control. That is a relatively small group of patients in my experience. Patients have a lot of issues coming up. The idea of being able to start with Q4-week dosing is pretty liberating for a lot of patients. Even if it means 2 shots at that time instead of 1, I think that's relatively a small issue. The real issue is the temporal aspect of it. So doing one shot or two shot, it's shot day, but being able to make shot day instead of every 2 weeks, every 4 weeks is actually kind of a breakthrough, especially when we look at it from the very start.

I think that we are much better than just a few years ago, so I'm really excited about that, and I feel very empowered and I actually feel lucky that I can now give my patients several options from some injectable agents to some oral agents. We really have some things to talk about, but I still see a huge number of patients admittedly very biased because I'm getting the referrals that haven't done well with the existing treatments, but I can speak on my own clinic that I have a lot of unmet need; patients for whom they didn't get enough of the response. It's like, golly, I wish we had another option. So we see all of these pieces and it's just so nice to be able to have something new and ideally something better. I think we're always looking to raise the goal, that treat to target goal from just saying, “hey, you're a little bit better. You'll push through it,” to “you're much, much better.”

As we saw and as we understand, many patients with atopic dermatitis have other atopic comorbidities. And of course, these include things like asthma and allergic rhinitis and food allergy and other things. And we're lucky that we understand that some of the pathways for these atopic diseases are shared. We know that at least theoretically, one medication can treat multiple conditions. And I think that's a huge, that's a huge impetus for patients to look for those, especially when it's appropriate. For that group of patients, they might say, “gosh, I'm on two different things. Is there a medication that I could switch to?” instead of maybe they're using just topical medicines for their atopic dermatitis, and maybe they're using an inhaled type medication for their asthma? Is there something that could potentially address both of those things at once? And I think when there is, many patients are motivated to do that.

I'm excited that I think we have entered into this phase that I call the virtuous cycle of drug development, where we finally learned enough about atopic dermatitis to get us some better treatments. Those first kind of first-generation treatments have given us more information about the molecular basis of the disease, so now we're seeing new and better refined treatments, which will allow for better understanding of the disease and better control. I really think that we're seeing this happen. And a lot of that comes from targeted approaches. We understand that we can turn off the immune system broadly and get people better. But at what cost? We see this tremendous trade-off. If we shut down all of one's immune system, we're in big, big trouble. Finding the appropriate targets and targeting just those particular aspects can really be the difference between somebody who is not only better, but better safely and better durably for a long time that they can actually maintain. And I really think we're there.

I think we're seeing tremendous interest in finding better metrics that are deeper than just how the patient looks that day or even how their itch has been for the past week. We really want to see the impact on quality of life. We're looking at these longer, more durable patient reported outcomes and I find that many of my patients, even if they look good that day and maybe their IGA score is pretty good, when I ask more penetrating questions and get more feedback, there are still unmet needs. Asking those questions and probing, I think will allow us to continuously refine and improve our therapies and I think is great feedback, which will help inspire the new approaches we're going to take in the future.

And that concludes our video series. I want to thank you for watching and on behalf of ASLAN Pharmaceuticals, thank you so much for joining us today.

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