A Conversation About JAK Inhibitors in Atopic Dermatitis - Episode 9

The Future of Atopic Dermatitis Treatment

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Raj Chovatiya, MD, PhD, and Lisa Swanson, MD, FAAD, explore the impact of recent advances in atopic dermatitis treatment and look to future possibilities.

Raj Chovatiya, MD, PhD: In our last couple of minutes together I really want to look toward the future a bit and pick your brain, Lisa, on what you anticipate is going to be happening as far as the treatment landscape of atopic dermatitis going forward. What are some of the challenges that you see? What are some of the specific things you want to know more about when it comes to your patients or specific populations and emerging therapies or future investigations?

Lisa Swanson, MD, FAAD: I often will say that the last 10 years have been about psoriasis and the next 10 will be about atopic dermatitis. You look at the options available for systemic therapies for moderate to severe plaque psoriasis and the list is so long now, and that’s a wonderful thing. But atopic dermatitis has kind of taken a back seat until recently. I think in the next few years there’s just going to be more and more options in our toolbox, and that’s going to be very exciting for us and our patients. I often would use the analogy that picking a systemic agent to treat bad atopic dermatitis before we had some of these new therapies was like picking a port-a-potty out of a row of port-a-potties. You know they’re all going to suck, but you’ve got to pick one when you have to go. Now we don’t have to pick port-a-potties anymore and we’re going to have more and more nice facilities to choose from as time goes on. We’re going to see the approval of another IL13 inhibitor; that’s going to be great and awesome. We’re going to get more topical therapies that are in the nonsteroid category; I can’t wait for those. And just more and more options to offer our patients. It’s going to be the golden age of dermatology.¼This is a great time to be in medicine.

Raj Chovatiya, MD, PhD: I look forward to the porcelain toilets that are coming our way as well, to think about it nicely. Some of the questions that I still have, and that I want to answer and understand better, are just general questions that plague us in atopic dermatitis. What exactly is control? How do we define control? What does being well controlled on medication mean? Are we treating toward a target? Is this more of a patient-reported thing? What drugs are getting us to that standpoint? What does it mean to flare? What exactly is that defined as? What drugs are going to be the best for which patient when it comes to suppressing flares? Is that going to be different from patient to patient? And if that’s the case, is there really a true biomarker we’re ever going to find, or do we really just need to understand clinical data and patient-related data and create the best phenotype we can for therapeutic selection? That’s some of the stuff that I think about. It’s what I really think is the Holy Grail. How do you match the right patient with the right therapy, knowing that we’re going to have dozens of options over the next several years¼if things make it all the way through the trial pipeline.

I hope that we do a great job of just expanding the actual diversity of our trials and making sure that we are getting patients from all corners, all skin types, all backgrounds, all comorbid statuses, and doing a good job of understanding what that means to them. I think we probably need to start reimagining, if not the definition of atopic dermatitis, just type 2 inflammatory disease in general and everything falling under that umbrella that isn’t exactly atopic dermatitis but sure seems to be some sort of eczema. Hopefully we can try to get additional indications on label so we can have more options for people that don’t truly have bona fide atopic dermatitis. And finally, a plea to all of our pharmacies and payers out there, really making sure that we can get therapies to patients who need them, even if they don’t meet specific criteria that sometimes seem a little arbitrary to us.

Lisa Swanson, MD, FAAD: I would also chime in with, I hope the future holds that age indications get younger over time with future studies. We have dupilumab down to age 6 months, and that’s super great, but I’d love to see some of these newer therapies gradually, over time, in a safe way, have lower age indications because there are a lot of kids that need a little bit more help.

Raj Chovatiya, MD, PhD: That is a perfect point to leave us off on. I think our time is up. A big thank you to everyone for tuning in. I’m Dr Chovatiya. I’m so happy to be joined by Dr Swanson. It’s really been a pleasure to talk to you about JAK inhibitors and atopic dermatitis.

Lisa Swanson, MD, FAAD: Thanks, Raj.

Transcript edited for clarity