Victoria Johnson joined the MJH Life Sciences in 2020 and has written for NeurologyLive, CGTLive, and now HCPLive. You can reach her at vjohnson@mjhlifesciences.com

Victoria Johnson

(AD) has undergone a profound transformation, especially within pediatric care. Once managed primarily through topical corticosteroids and broad anti-inflammatories, the field now benefits from an expanding toolbox of targeted, nonsteroidal therapies designed to deliver efficacy without compromising safety. This evolution has been driven by growing recognition of the long-term consequences of chronic inflammation in children—from disrupted sleep and impaired growth to emotional and family strain—and by the emergence of innovative topical agents such as ruxolitinib (Opzelura), tapinarof (Vtama), and roflumilast (Zoryve).

 Their approvals between 2021 and 2024 mark a turning point, offering clinicians and families alternatives that balance disease control with parental concerns over steroid exposure.

At the same time, the philosophy of care for pediatric AD is shifting from reactive flare management toward proactive, sustained disease suppression. Dermatologists and allergists are increasingly emphasizing early intervention, consistent barrier repair, and individualized maintenance therapy to prevent exacerbations before they begin. Yet, systemic challenges remain—insurance restrictions, limited pediatric data, and educational gaps among families and primary care providers continue to hinder optimal use of these therapies. Within this context, recent expert discussions have underscored how the integration of nonsteroidal topicals, patient education, and age-tailored treatment strategies together represent not just incremental progress, but the foundation of a safer, more holistic era in pediatric atopic dermatitis management.

 in Miami, Florida, allergists and dermatologists led by Vivian Trujillo-Hernandez, MD, Director, Division of Allergy & Immunology, Nicklaus Children's Hospital, gathered to discuss the evolving management of pediatric atopic dermatitis, emphasizing the importance early, proactive, and personalized care.

"The typical profile of the patient that comes to my clinic is usually babies or the less than 5-year olds that have eczema and then the parents want food allergy testing," one panelist said. "So I think it's a lot of education with those patients that you don't necessarily have to avoid that food. You can limit it in some form [but] you don't want them to take that completely away from their diet, if the reaction is eczema, for example."

Panelists highlighted the limitations of steroids and the growing preference for nonsteroidal options like ruxolitinib, tapinarof, and roflumilast, which offer improved safety, efficacy, and adherence. The group discussed practical challenges, including parental steroid phobia, education gaps, cost barriers, and long-term safety in young patients, while noting how newer agents and proactive maintenance strategies can reduce flares, itch, and caregiver burden. 

"It's very emotionally traumatic for the parents to... see their kids suffering... It is also a very difficult decision because a medicine like Dupixent sounds like a big deal to a baby. It's like, am I giving something to my baby that's going to harm them later? But at the same time, nothing's working. And, do I trust that this doctor's telling you the truth that it's safe? And maybe the doctor believes it, but doctors have been wrong. So it's a very difficult, loaded visit for me," another panelist said.

They emphasized that pediatric management centers around age-specific approaches, and stressed education, empowerment, and shared decision-making to support sustained control and quality of life improvements, and acknowledged the importance of allergy-dermatology collaboration.

"I think referring to allergies, the collaborative nature of our specialties is crucial. And I think that you have those patients that walk in and you know what they need. Sometimes they need to get the reassurance and have these [allergy] tests done... just to make them comfortable. And then vice versa, where that's the main cause. But then they think it's something from the outside and then they come to us to reassure them," a panelist said.

Shirley M. Dupilumab: First Global Approval. 

. 2017;77(10):1115-1121. doi:10.1007/s40265-017-0768-3.

Nevid M, Boguniewicz M. Current and Emerging Biologics for Atopic Dermatitis. 

. 2024;44(4):577-594. doi:10.1016/j.iac.2024.08.001

Smith T. FDA Approves Tapinarof 1% Cream for Adult, Pediatric Patients with Atopic Dermatitis. HCPLive. Article. December 16, 2024. https://www.hcplive.com/view/fda-approves-tapinarof-cream-adult-pediatric-patients-atopic-dermatitis

Articles

Over the last decade, pediatric atopic dermatitis (AD) management has evolved significantly, moving from traditional corticosteroids to targeted nonsteroidal therapies like ruxolitinib, tapinarof, and roflumilast. This shift addresses the long-term impacts of chronic inflammation in children and parental concerns over steroid use. The focus is now on proactive, sustained disease suppression, emphasizing early intervention and individualized care. However, challenges such as insurance restrictions, limited pediatric data, and educational gaps persist. Collaborative efforts between dermatologists and allergists are crucial for effective management and improved quality of life.

Experts discuss the latest advancements in pediatric atopic dermatitis treatment.

Eliminating the Itch: How Nonsteroidal Topicals Are Changing Pediatric Atopic Dermatitis Care

Low-Dose IL-2 Rebalances Immunity in SLE, With Yuebo Jin, MD

Low-dose interleukin-2 (IL-2) therapy is showing growing promise as a novel approach to immune modulation in systemic lupus erythematosus (SLE), aiming not to suppress immunity but to restore balance.

New data supporting the feasibility and benefit of low-dose IL-2 from a multicenter, randomized, double-blind, phase 2b trial were presented at the 

American College of Rheumatology (ACR) Convergence 2025

, held October 24–29 in Chicago, Illinois, by Yuebo Jin, MD, associate professor, Department of Rheumatology and Immunology, Peking University People’s Hospital, Beijing, China.

The trial evaluated 3 different doses of low-dose IL-2, 0.2, 0.5, and 1.0 million IU, in 152 patients with active SLE. Over 24 weeks, investigators found a clear dose-dependent benefit, with the highest dose achieving the strongest clinical responses: 60% of patients receiving 1.0 million IU reached SRI-4 response criteria compared with 23% of those on placebo.

Low-dose IL-2 was also associated with improvements across multiple organ systems, including skin, hematologic, and renal domains. Complement levels increased, and corticosteroid requirements decreased—an encouraging signal for patients struggling with long-term steroid dependence. Notably, infection rates were significantly lower in the IL-2 arms than in the placebo group, underscoring the distinct safety profile of immune-balancing rather than immune-suppressive therapy.

Mechanistically, the treatment selectively expanded regulatory T cells (Tregs) while reducing proinflammatory effector T cells, restoring the immune equilibrium that is often disrupted in lupus. In an interview with 

onsite at the meeting, Jin noted that these effects make low-dose IL-2 a compelling candidate for combination strategies, potentially used alongside biologics or conventional immunosuppressants to maintain remission and minimize toxicity.

She also shared ongoing and future research that aims to deepen understanding of IL-2’s immunologic and metabolic effects, explore new long-acting and localized formulations, and develop AI-driven tools to predict treatment response using multiomics data.

"What's very interesting thing is that the infection rates in the IL-2 groups are significantly lower than placebo, which is very different from traditional immunosuppressants. In terms of immune response, low-dose IL-2 expanded Treg cells and help rebalance Treg and effector T-cells [and] is working the way we expected," Jin said.

Zhang X, Feng R, Li Z, He J. Low-dose Interleukin-2 Therapy in Systemic Lupus Erythematosus: a double-blind, randomised, placebo-controlled, phase IIb trial. Presented at: ACR Convergence 2025; October 24-29; Chicago, Illinois. Poster #LB01

Videos

Jin discussed new evidence supporting the immune-modulating effects of low-dose IL-2 at ACR 2025.

Achieving “State Zero”: New Data on Bimekizumab, Other IL-17is, Transform PsA Treatment Goals, with Philip Mease, MD

Interleukin-17 (IL-17) inhibition continues to evolve as a major frontier in psoriatic arthritis (PsA) treatment, with new data on both approved and investigational therapies recently presented at the 

, held October 24–29 in Chicago, Illinois, by Philip Mease, MD, Clinical Professor at the University of Washington and Director of Rheumatology Research at the Swedish Medical Center in Seattle.

Mease spoke about key findings on several IL-17 targeting agents, bimekizumab, sonelokimab, and izokibep, that are shaping current and future management strategies for PsA. 

New data on bimekizumab, a dual IL-17a/17f inhibitor, reinforce the importance of achieving complete remission across clinical domains, or "state zero." Mease and colleagues found that when patients reach “state zero”—meaning full resolution of manifestations such as swollen joints, enthesitis, or radiographic progression—they experience substantial parallel improvements in pain, function, and overall quality of life. 

Meanwhile, new phase 2 data on sonelokimab, a nanobody IL-17A and IL-17F inhibitor, demonstrated that at 24 weeks, more than half of treated patients achieved major composite outcomes such as ACR50 and minimal disease activity, with responses spanning key domains of arthritis, enthesitis, and skin involvement.

Lastly, Mease discussed 1-year outcomes from izokibep, a small molecule IL-17A inhibitor with a compact protein scaffold design, which demonstrated durable efficacy through 52 weeks. Patients maintained high rates of ACR50 responses, functional improvement, and sustained low disease activity, suggesting that next-generation small molecule constructs may rival biologics in depth and durability of response.

"There's a correlation with improvements in other important areas for patients, really low states of pain, improvement in function, quality of life. And so it just reinforces the message that what we're trying to get to in a disease is complex," Mease said.

Mease's disclosures include AbbVie, ACELYRIN, Amgen, Bristol Myers Squibb, Century Therapeutics, Cullinan Biotech, Eli Lilly, Genascence, GRAPPA, Immagene, Johnson & Johnson, MoonLake Immunotherapeutics, Novartis, OMERACT, Pfizer, SPARTAN, Takeda, and UCB Pharma.

Mease PJ, Poddubnyy D, Bajracharya R, et al. Long-Term Safety and Tolerability of Bimekizumab Treatment Across Phase 2b and Phase 3 Studies in Patients with Axial Spondyloarthritis or Psoriatic Arthritis: 3-Year Update from the Phase 3 Studies. Presented at: ACR Convergence 2025; October 24-29; Chicago, Illinois. Poster #1454

Mease PJ, Gossec L, Deodhar A, et al. Sonelokimab in Patients With Active Psoriatic Arthritis Who Are Naive to Biologic DMARDs: Phase 2 ARGO Analysis and Phase 3 IZAR-1 Study Design. Presented at: ACR Convergence 2025; October 24-29; Chicago, Illinois. Poster #1455

Mease PJ, Behrens F, Kivitz AJ, et al. Efficacy and Safety of Izokibep, a Novel IL-17A Inhibitor, in Patients with Active Psoriatic Arthritis: Week 52 Results from a Randomized, Double-Blind, Placebo-Controlled, Multicenter, Phase 2b/3 Study. Presented at: ACR Convergence 2025; October 24-29; Chicago, Illinois. Poster #LB08

Mease discussed the latest updates on bimekizumab, sonelokimab, and izokibep at ACR Convergence 2025.

Khanna explains recent findings of Nanoencapsulated Sirolimus Plus Pegadricase improvement of uncontrolled gout symptoms.

NASP Treatment Uncontrolled Gout With Puja Khanna

Findings from a recent study on Nanoencapsulated Sirolimus Plus Pegadricase (NASP) treatment for uncontrolled gout show improved sUA levels, patient-reported outcomes, and health-related quality-of-life (HRQOL) in patients1.

The phase 3 DISSOLVE Trials investigated the effects of NASP, formerly SEL-212, a 2-component infusion therapy made up of nanoencapsulated siroliumus, aimed to reduce the formation of anitpegadricase antibodies and uricase, which is meant to lower sUA

“NASP has been shown to reduce the number of swollen and tender joints, and the health-related quality-of-life measures, maintained at a level of above 80% across the board, whether patients took the high-dose NASP or the low-dose NASP,” said Puja Khanna, MD, MPD, University of Michigan, in an interview with 

the American College of Rheumatology (ACR) Convergence 2025

. “So at the end of the day, this drug is showing promise that patients who have not previously responded to the oral therapies, despite being on full doses, have hope that they can attain remission.”

The trial included patients with a history of symptomatic gout, defined as ≥ 3 gout flares within 18 months of screening, 1 or more tophus, or current gouty arthritis, inability to normalize sUA, and control symptoms with treatment, and 7 mg/dL or more of sUA.

After applying the eligibility criteria, patients were randomized in a 1:1:1 ratio to receive 6 treatments of high-dose NASP (0.15 mg/kg NAS; 0.2mg/kg P), low-dose NASP (010 mg/kg NAS; mg/kg P), or placebo on a 4-week basis. Patient-reported outcomes were measured by a 36-Item Short Form Health Survey physical component summary score and Health Assessment Questionnaire-Disability Index pain score.

The week 1 baseline for HD NASP (n = 42), LD NASP (n = 35), or placebo (n = 67) (mean SD: 8.5 (1.4), 8.5 (1.3), and 8.7 (1.6) mg/dL compared to mean 1.1 (2.0), 0.5 (0.8), and 8.5 (2.0) mg/dL at week 24. For high-dose NASP, the means were reduced for sUA (-88%), tender joints (-74%), swollen joints (-90%), and pain score (-60%). For low-dose NASP, mean sUA reduced (-94%), tender joints (-92%), swollen joints (-90%), and pain score (-80%). For PBO, means were sUA, (-0.3%), tender joints (-40%), swollen joints (-54%), and pain score (-44%).

Further analysis of the results demonstrated significant improvement in uncontrolled gout symptoms in patients who received either a high or low dose of NASP. After the first dose of NASP, sUA levels were immediately reduced and remained ≤2.0 mg/dL. By the conclusion of the trial, there was a 2-fold reduction in the mean number of tender and swollen joints in the high-dose and low-dose NASP compared to PBO. The mean recorded patient outcome scores showed improvement (High-dose NASP, 5.9; Low-dose NASP, 9.7) and were 2-fold higher than the patients in the PBO cohort.

“The next steps would be to understand whether the six-month therapy is the end, or whether it needs to be continued for another six months. How many courses of NASP would a patient need? Because for every patient with uncontrolled gout, multiple flares, a massive amount of TOPHI deposits, it's not the same,” said Khanna about what she hopes to see in future research. “All of that data will have to be collected long-term before we can decide NASP is the drug of choice. Patients can have more options now. This space, unfortunately, has been very limited.”

Nanoencapsulated Sirolimus Plus Pegadricase Reduced Disease Burden in Patients With Uncontrolled Gout: Results From the Phase 3 DISSOLVE Trials - ACR Meeting Abstracts. ACR Meeting Abstracts. Published 2025. Accessed October 30, 2025. 

https://acrabstracts.org/abstract/nanoencapsulated-sirolimus-plus-pegadricase-reduced-disease-burden-in-patients-with-uncontrolled-gout-results-from-the-phase-3-dissolve-trials/

‌Herbert, Khanna PP, Kivitz A, et al. The COMPARE head-to-head, randomized controlled trial of SEL-212 (pegadricase plus rapamycin-containing nanoparticle, ImmTORTM) versus pegloticase for refractory gout. 

https://doi.org/10.1093/rheumatology/kead333

Recent trial findings show Nanoencapsulated Sirolimus Plus Pegadricase can improve symptoms of uncontrolled gout.