The Latest in Dermatology With James Del Rosso, DO: Part 2

At the 44th annual Fall Clinical Dermatology Conference held in Las Vegas, Nevada, from October 24 to 27, James Del Rosso, DO, presented “What’s New in the Medicine Chest” parts 1 and 2. Del Rosso, research director and principal investigator at JDR Dermatology Research in Las Vegas, Nevada, and clinical advisor of Fall Clinical, reviewed the latest updates in FDA-approved treatments for various skin conditions, as well as awaited new indications.

During his second session, Del Rosso discussed numerous available and upcoming monoclonal antibodies and JAK inhibitors, including nemolizumab (Nemluvio; Galderma); lebrikizumab (Ebglyss; Eli Lilly and Company); tralokinumab (Adbry; LEO Pharma); dupilumab (Dupixent; Sanofi & Regeneron); remibrutinib (Novartis); bimekizumab (Bimzelx; UCB Pharma); secukinumab (Cosentyx; Novartis); upadacitinib (Rinvoq; AbbVie); and heat shock protein inhibitors.

Del Rosso’s Key Takeaways

1. Nemolizumab

Nemolizumab, approved for prurigo nodularis in adults, targets interleukin-31 (IL-31), a cytokine heavily involved in inflammation pathways associated with intense itching. Clinical trials show its efficacy in reducing pruritus and managing skin lesions, specifically nodules, in patients with moderate to severe disease. Many patients in the trial had over 100 nodules, highlighting its application in more advanced cases. With anticipated approval for atopic dermatitis, nemolizumab offers benefits in itch reduction and skin barrier enhancement while mitigating fibrosis. By addressing multiple inflammatory pathways, nemolizumab may evolve into a vital treatment for dermatological conditions with severe itch and skin thickening.

2. Lebrikizumab

As an IL-13 inhibitor, lebrikizumab targets a cytokine central to the pathogenesis of atopic dermatitis (AD). Recent studies confirm its role in reducing pruritus, improving skin barrier function, and achieving a range of clinical efficacy endpoints. Notably, its effects appear durable: many patients maintained symptom control even after treatment cessation. Lebrikizumab and tralokinumab, another IL-13 inhibitor, have proven safe without necessitating baseline monitoring, and both lack FDA-mandated black box warnings. Unique binding mechanisms may yield slightly different clinical outcomes, and flexible dosing options enable clinicians to adapt therapy as disease control improves, according to Del Rosso.

3. Tralokinumab

Approved for both adolescent and adult patients with atopic dermatitis, tralokinumab also targets IL-13, though it binds a distinct portion of the cytokine compared to lebrikizumab. This distinction may impact specific patient responses or tolerability. Clinicians can adjust dosing from biweekly to monthly based on treatment response, and an auto-injector option improves administration convenience. Tralokinumab offers long-term disease management with minimal adverse effects, providing stable control of AD without systemic toxicity risks, making it a promising first-line biologic for moderate to severe cases.

4. Dupilumab

A longstanding option in dermatology, dupilumab has extensive safety and efficacy data for patients with atopic dermatitis aged 6 years and older. Unlike IL-13-specific inhibitors, dupilumab blocks IL-4 and IL-13, delivering broader cytokine pathway inhibition. This biologic has set benchmarks for AD treatment efficacy and durability and is also under investigation for chronic spontaneous urticaria and bullous pemphigoid. Notably, patients can safely resume dupilumab therapy after pausing it, as clinical data show effective disease recapture, reinforcing its reliability for long-term use in AD and potential future indications.

5. Remibrutinib

Remibrutinib, a Bruton kinase (BTK) inhibitor, is an oral agent under investigation for chronic spontaneous urticaria. As a BTK inhibitor, it could offer an alternative to injectable biologics for dermatologic use. Although not yet FDA-approved, remibrutinib shows favorable safety and efficacy, with anticipated availability as early as 2025. Its potential as a first-in-class oral biologic offers substantial promise for patients preferring non-injection options.

6. Bimekizumab

Bimekizumab, effective for both psoriasis and psoriatic arthritis, inhibits IL-17A and IL-17F, achieving superior efficacy metrics such as PASI 90 and PASI 100 in trials. Candidiasis, a manageable adverse effect, is more common due to dual IL-17 inhibition. This dual blockade facilitates rapid and robust improvement, even with extended dosing intervals after initial disease control. Now approved for psoriatic arthritis, it additionally prevents radiographic disease progression, preserving joint health in affected patients.

7. Secukinumab, Upadacitinib, and Other Hidradenitis Suppurativa Therapies

Secukinumab, targeting IL-17, is FDA-approved for hidradenitis suppurativa (HS), a challenging condition characterized by painful abscesses and fistulas. Given the need for early, aggressive treatment to limit scarring, new biologics like bimekizumab show potential in HS. Additionally, JAK inhibitors such as upadacitinib and emerging therapies (e.g., heat shock protein inhibitors) are under development, indicating a future of more personalized, effective HS care.

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