Amy S. Paller, MD: Systemic Atopic Dermatitis Therapy for Pediatric Patients


The Feinberg School of Medicine expert discusses the impact of dupilumab and other biologics on severely affected children and adolescnets.

Biologic therapy capability, indications, and availability has boomed in the past half-decade, coming to help redefine the potential of moderate-to-severe inflammatory disease treatment among adults.

Now, at least in dermatology, it’s beginning to reach the youngest eligible patients.

In an interview with HCPLive during the American Academy of Dermatology (AAD) 2022 Annual Meeting in Chicago, Amy S. Paller, MD, Chiar of the Department of Dermatology at Northwestern Feinberg School of Medicine, discussed the increasing research and regulation of biologic therapies for children with atopic dermatitis.

Just dupilumab (Dupixent)—which is awaiting another US Food and Drug Administration (FDA) decision this year on indication for children aged 6 months to 5 years old with atopic dermatitis—is currently available for patients as young as 6 years. “But I do think that is just the beginning of having a broad array of highly effective therapies for children,” Paller said.

Paller explained how dermatologists and children’s parents/guardians previously weighed the benefits and risks of initiating systemic therapy very deliberately—whether or not to initiate added steroids, whether to test a short-term dose of methotrexate, and on.

“Now it’s much easier, because we have a medication that really doesn’t need any lab monitoring, that has some conjunctivitis that can generally be treated pretty easily, some mild injection site reaction—but otherwise really in the vast majority of children has no side effect whatsoever,” Paller said.

Some shortcomings persist with new biologics: they are costly, and sometimes difficult to access for potentially suitable patients. But Paller said the previous state of treatment capability for such young patients—including some who could even take twice-daily topical therapy without achieving any skin clearance—makes the hurdles worthwhile.

Paller additionally discussed the unique burdens of severe pediatric atopic dermatitis, including psychosocial impacts, emotional harm, and sensations including itching that can affect sleep health and attention spans.

“We also have to think about quality of life, and when we’re reducing itch and improving sleep, we’re markedly affecting their quality of life,” Paller said.

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