The Mount Sinai Dermatology chair reviews headlines from the 2022 meeting before sharing perspective on developing drugs and topics.
The field of atopic dermatitis care is nearly unrecognizable from only a decade ago, with the explosion of biologic and immunologic-targeting agents reaching the market and broadening the scope of research into future treatment options. Drug classes are rapidly expanding, and the dermatologist’s capability to tailor care is becoming more refined.
Only more progress will come from this exciting trend at the American Academy of Dermatology (AAD) 2023 Annual Meeting in New Orleans this week, when more late-stage data and discussions around more recent candidates come to light.
In an interview with HCPLive leading up to AAD 2023 this weekend, Emma Guttman-Yassky, MD, PhD, system chair of dermatology and immunology at the Icahn School of Medicine at Mount Sinai, discussed some of the most recent developments in atopic dermatitis management, and her most anticipated discussions for the annual dermatology meeting.
HCPLive: It seemed as if JAK inhibitors in atopic dermatitis were really a headline discussion last year at AAD 2022—a lot of discussion around abrocitinib, ruxolitinib cream, some of these emerging therapies like OX40 inhibitors and otherwise.
What are your thoughts on the status of our capability to treat the right patients with the right parameters?
Guttman-Yassky: It's getting better and better. The field is getting better. We have an entire treatment armamentarium—we have several biologics already approved. Of course dupilumanb was the first one that is already approved, even in babies 6 months and up; we have tralokinumab also approved. We have 2 JAK inhibitors—you've heard the news that abrocitinib also got the adolescent label. So both upadacitinib and abrocitinib are now approved for adolescents and adults. We have a topical JAK inhibitor, ruxolitinib, approved as well for ages 12 and up. And now we have some exciting new developments in clinical trials that may even be help disease modification features, like the OX40 antagonists, as well as the CCR4 inhibitors that is an oral medication in clinical trials. So it's super exciting times for the disease.
Can you further discuss abrocitinib's recent FDA approval for adolescent patients?
It's exciting, because particularly in adolescents, we are seeing many patients that just do not want an injectable, you know? So it's good to have that option because some people want only an oral, and particularly in adolescents and children, we see that when their parents tell them to do one thing, it's fine—but if they don't want to get an injection, they will not have it. So I think it's great news for patients and also in the summer, we will have likely another IL-13 team coming: lebrikizumab. So again, super exciting times.
Staying on the subject of adolescent management, speaking specifically to age-specific care strategies in atopic dermatitis right now and where we're advancing research: there's been a lot of prioritization of developing pediatric indications and expansions for biologics and otherwise.
Do you see any other pertinent age-related or patient populations that we still need to cross some thresholds in getting treatment options?
Absolutely. I'm very passionate about that, because a lot of my research is on different patient populations. For example, based on ethnicity, Asians have a higher TH17 immune abnormality, and African Americans have more TH2 burden. So there are differences based on ethnicity, age, and so on. I think once we have more drug, it will be very nice to stratify based on all of these features to understand which drug for which patient.
If we turned toward biologic therapy: talking to trends that were really headlined at AAD 2022 and even in years prior, they really honed in on optimal care strategy—achieving long-term disease management, symptom relief through lessened administrations, etc.
What are you looking forward to in the discussion around that topic at AAD 2023?
When we think about long term, we think about treatments that are safe long-term. I think that is an important feature for us, including in adolescents and in younger children. Also, the monitoring of these patients—how often we need to check in, conduct our blood monitoring, and so on.
In terms of emerging agents, specifically in biologics for atopic dermatitis, is there anything that you're anticipating in terms of new data presentations or continued discussion around research?
We are super excited about the imminent approval of lebrikizumab, the IL-13 antagonist that is coming hopefully this summer. It's very anticipated. It will be amazing to have another a very strong biologic that works very well on patients. Also, it's given every 2 weeks and every 4 weeks, which is great. We just had the approval of abrocitinib, of course, for adults and adolescents.
And there are some exciting developments also for chronic hand eczema. We now have delgocitinib, for which they just announced very positive clinical trial data. Chronic hand eczema has a lot of similarity to eczema, but it is its own thing because it also involves contact dermatitis, but I view it as a sister of eczema in a way.