On the Radar: Emerging Biologics, Topical Anti-Inflammatories, and Systemic Treatments for AD

Atopic dermatitis (AD), the most common inflammatory skin disease affecting both children and adults, results in significant impairments in patients’ quality of life (QoL), particularly when the disease is inadequately controlled. Within the last few years, however, approvals for targeted treatments such as crisaborole (Eucrisa; Pfizer) and dupilumab (Dupixent; Sanofi and Regeneron Pharmaceuticals) have led to dramatic improvements in symptom control and outcomes for patients with AD.

Despite availability of targeted therapies for the disease, some patients with AD who receive only topical agents consequently experience uncontrolled disease and decreased QoL, highlighting the need for better treatment options for this patient population.¹

Newer therapies with various mechanisms of action have recently shown promise for meeting the current gaps in AD treatment.

A mini symposium at the 4th Annual Revolutionizing Atopic Dermatitis 2022 Conference, held virtually and in Baltimore, Maryland highlighted emerging oral systemic therapies, anti-inflammatory agents, and up-and-coming biologics for AD.²

Symposium moderator Jonathan Silverberg, MD, associate professor of Dermatology at The George Washington University School of Medicine and Health Sciences in Washington, DC, opened the session with a discussion on emerging topical anti-inflammatory therapies for AD. In addition, Silverberg provided a broad discussion and update on emerging biologics for the treatment of the condition.

David Rosmarin, MD, FAAD, clinical investigator and vice-chair for research and education at Tufts Medical Center, Boston, Massachusetts, also detailed emerging oral systemic therapies for AD during the mini symposium session. Oral therapies recently FDA-approved for AD include the selective Janus kinase (JAK) inhibitors abrocitinib (Cibinqo; Pfizer), baricitinib (Olumiant; Eli Lilly and Company), and upadacitinib (Rinvoq; AbbVie). The recent approvals for these drugs have expanded the therapeutic landscape for AD, offering the potential for improved outcomes in symptom control in patients with inadequate or intolerable responses to standard therapies.

“For many years, we've had topical corticosteroids and calcineurin inhibitors as mainstays of topical anti-inflammatory treatments in AD,” Rosmarin commented. “It is an exciting time to have additional options to help patients.”

While effective, JAK inhibitors contain black-box warnings, given clinical trial observations of cardiovascular-related safety signals with this drug class.³ “Every medicine has side effects,” Rosmarin explained, “and we always need to make sure the benefits outweigh the risks when treating patients with AD and improving the patient's QoL.”

“We are seeing new options for AD in multiple areas, and every new treatment has its advantages and drawbacks,” Rosmarin added. “Some medications may be better for itch, some are more rapid, and some have an oral route or different frequency of injections. With additional options, we can provide optimal care for our patients.”

References:

1. Anderson P, Austin J, Lofland JH, Piercy J, Joish VN. Inadequate disease control, treatment dissatisfaction, and quality-of-life impairments among US patients receiving topical therapy for atopic dermatitis. Dermatol Ther (Heidelb). 2021;11(5):1571-1585.
2. Rosmarin D, Silverberg J. Mini-Symposium 4: Emerging systemic therapies in AD. Presented at: 4th Annual Revolutionizing Atopic Dermatitis Conference, held April 9 to 11, 2022, in Baltimore, Maryland.
3. US Food and Drug Administration. FDA requires warnings about increased risk of serious heart-related events, cancer, blood clots, and death for JAK inhibitors that treat certain chronic inflammatory conditions. Published September 1, 2021. Accessed April 8, 2022. Available from: https://www.fda.gov/drugs/drug-safety-and-availability/fda-requires-warnings-about-increased-risk-serious-heart-related-events-cancer-blood-clots-and-death