Staying Up-to-Date on Approved Therapies in Atopic Dermatitis

In this MedPage Today video, James Del Rosso, DO, of Touro University College of Osteopathic Medicine in Henderson, Nevada, stresses the importance of staying updated on established and emerging treatments for atopic dermatitis.

Following is a transcript of his remarks:

I think it’s really important to be looking at, with a variety of these different disease states, to really keep an open mind. And there’s a variety of different approved therapies. We have, for example in atopic dermatitis, we have dupilumab [Dupixent], which has been around for some time and has really changed life for many, many patients. And it inhibits IL [interleukin]-4 and IL-13, which are major cytokines in many of the patients that are overexpressed. So it stands to reason why it significantly helps a lot of patients.

But then we have anti-IL-13 agents, one that is available and a couple more that are being worked on. We have tralokinumab [Adbry], and tralokinumab, there’s really important data with tralokinumab to look at.

And so when people try to start comparing these different drugs, my message is learn each one of them, learn each one of them individually because they’re all approved therapies — the ones that are approved, those are the only ones we can get — they’re approved because they work. And there are patients that they can certainly apply to. And there are some differences, even drugs that are in the same mechanistic class, there are some differences where sometimes one might be a better option or [a] patient had trouble with another. And the therapy that in your own mind you’re like, “Well, I don’t think that works as well.” In some of these patients it does. It will help. And there’s a lot of good reason to believe that.

Then we have the Janus kinase inhibitors, and that’s an expanding field because that’s a very important, it’s not just one mechanism of action. There are many Janus kinase enzymes, and depending on which ones you’re inhibiting, where they cross over to different diseases is extremely important to be able to differentiate both in terms of efficacy and safety.

So the good news is…I doubt you would go to a restaurant that only served one thing on the menu unless you knew that that’s exactly what you wanted. It’s great to have choices on the menu because one day one might be a better choice for you, the next day it might be another, and that’s the beauty of having these therapies. But you have to learn them and focus on each of them individually. So that’s what I try to do.

In atopic dermatitis, there is a mechanism called OX-40, OX-40 ligand, which is important in terms of Th2 and T cell activation and proliferation, but also memory. And one of the things we’re understanding is the reason why patients have many of these chronic diseases is they have memory cell lymphocytes that remember the problem, and when that problem is triggered, they’re just sitting there waiting to start trouble again. It’s like if you’re a teacher and you have troublemakers in the classroom, they may be quiet today, but you know they’re going to act up tomorrow. And we’re understanding those. And some of these therapies actually target the memory process. And OX-40, OX-40 ligand does direct that, and that has implications in terms of the chronic management, not just controlling the flare.

That’s one example of an exciting area.

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