New Drugs in 2023, Patient Satisfaction, and RAD Takeaways With Melinda Gooderham, MSc, MD, FRCPC

“When I walked up to the desk to get my badge [for RAD], they knew who I was. They knew my name before I even opened my mouth, so you don't get that at an AAD or an EADV,” said Melinda Gooderham, MSc, MD, FRCPC, medical director at the SKiN Centre for Dermatology. In an interview with Dermatology Times®, Gooderham reviewed what she enjoys about the Revolutionizing Atopic Dermatitis (RAD) conference, as well as highlights from 3 of her sessions on new drug approvals in 2023 and late-breaking data on patient satisfaction and quality of life improvement for patients with atopic dermatitis.

Transcript

Melinda Gooderham, MSc, MD, FRCPC: My name is Melinda Gooderham. I'm a dermatologist and clinical researcher from Peterborough, Ontario, Canada. I am an assistant professor at Queen's University and medical director at SKiN Health Center.

Dermatology Times: What are the highlights from your session, "Coming Soon in 2023?"

Gooderham: I'd say the highlights for the coming in 2023, although not all of the products will be approved probably in 2023, I've kind of extended that out to 2024 a bit. There are going to be a couple of new nonsteroidal topicals, a couple of new biologic options for our patients. The nonsteroidal topicals including topical roflumilast, which we are familiar with, it's a potent PDE4 inhibitor. It's approved for psoriasis already in the 0.3% cream formulation. They are now studying this in a 0.15% cream for the atopic dermatitis population. So we've seen some really good results with that and that will be coming as well as a topical tapinarof, another nonsteroidal which is a 1% cream also approved for plaque psoriasis in adults will likely be approved for atopic dermatitis as well, including children. And again another very effective treatment. They're both well tolerated, and I think in the era of topical steroid phobia and topical steroid withdrawal concerns, these non-steroidal topicals will really offer another option. There is not likely to be any warnings associated with these so patients can feel comfortable using them. So that's, I think, really exciting for the majority of atopic dermatitis patients, because whether you're mild, moderate, or severe, you're likely to use a topical agent. 

For the more moderate to severe population, 2 new biologics likely to be approved in the next year. One is lebrikizumab, it's another IL-13 monoclonal antibody. We have tralokinumab already, but the efficacy may not always be as high as we would like. So, to have another option for patients who may not be doing well, [we will have] lebrikizumab. You can see clearance rates similar to dupilumab, with maybe slightly lower conjunctivitisAEs. So good efficacy, hopefully, fewer AEs, although real-world use will give us that answer.

And then we have nemolizumab, which is a new mechanism of action from what we have available. It's an antagonist of the interleukin 31 receptor. So, we know the interleukin 31 Is the itch cytokine. And this molecule is already approved in Japan for itch associated with atopic dermatitis, we have no regulatory approvals in North America or Europe at this point. But that is another new option that will be available for those patients who may have an itch-predominant type of atopic dermatitis, that we see a lot of linkage with itch with sleep loss, work productivity, and just a reduced quality of life. So being able to control their itch with a safe monoclonal antibody, I think will really be beneficial to our patients.

Dermatology Times: What are some of the most important takeaway points from your late-breaker session on achievement of minimal disease activity and improvements in symptoms and QoL?

Gooderham: So this achieving minimal disease activity is a concept similar to a treat to target, but used more in a shared decision-making approach. So, you ask the patient to you know, up front, what is concerning them? What is bothering them? Is it the itch? Is it the skin pain? Is it the mental health issues? Is it the skin signs and symptoms, and then the patient sort of chooses what's important to them. And then we do clinician-reported assessments and patient-reported assessments with specific targets in mind. So, we have optimal targets. So this is good control of disease, we're talking like EASI less than 7, EASI90, and then we have more moderate targets. And what we showed in this post-hoc analysis of the upadacitinib trials, so the 3 phase 3 trials, Measure Up 1, Measure Up 2, and AD Up, that with looking at those approximately 2000 patients, those patients who achieved optimal disease control did the best with respect to skin signs and symptoms, work productivity, quality of life, treatment satisfaction on all of those domains. They did better than those who didn't achieve their targets on all of those domains, but not as well as the patients who achieved the optimal targets. So really the take home message just being the better you can achieve disease control, with a decision with the patient about what's important. So if itch is bothering them, you assess their itch, find a treatment that's going to deal with their itch, that is what is going to give them their best life, as far as quality of life work, productivity, sleep, all of those factors will be the best they can be with the best disease control.

Dermatology Times: What are the highlights from your 2nd late-breaker session on patient satisfaction with treatment for moderate-to-severe AD according to degree and speed of skin improvement?

Gooderham: So the other poster is also on treatment satisfaction. This was a web survey and about 200 patients, but it's a nice diverse population. And the one thing I like about this survey was that most of the patients were using topical therapy, I think 90%, and about 11% were using dupilumab, which will be the majority of our patients who are using topical therapy. And what we found was that patients who had good control of their itch, rapid control of their itch, were the most satisfied with their treatment, again, another way to prove or encourage clinicians to work with the patient to determine what is bothering the patient, what targets we're going to achieve and going after those targets so that we can improve the lives of our patients and improve their satisfaction with treatment.

Dermatology Times: What are the benefits of a smaller, more focused conference like RAD?

Gooderham: The benefits for a smaller conference for me is really just getting to chat with everyone, even from when I walked up to the desk to get my badge, they knew who I was, they knew my name before I even opened my mouth, so you don't get that at an AAD or an EADV. So that personal touch and the saying where everyone knows your name, I feel like you can just stop and chat with people you would never have even seen at one of the bigger meetings and it's also a group of like-minded individuals, right? We all have the same goal in mind. We have the same interests and it's really nice to all be in one room together with a common goal.

[Transcript edited for clarity]