Future Outlook for Atopic Dermatitis Treatments

Video content above is prompted by the following:

Please share final thoughts on the future of atopic dermatitis treatment with oral systemic agents.

The future of atopic dermatitis treatment with oral systemic agents is promising, with ongoing research and development of novel therapies. Advances in understanding the pathophysiology of atopic dermatitis have led to the identification of new therapeutic targets, resulting in the development of more effective and targeted treatments. These agents aim to provide better disease control, reduce side effects, and improve patient quality of life. The integration of personalized medicine approaches and biomarkers may further enhance treatment outcomes, offering tailored therapies based on individual patient profiles and disease characteristics.

Medical experts share their final thoughts on the future of atopic dermatitis treatment with oral systemic agents.

George Han, MD, PhD

Jared Hassler, MD, is a pathologist at the Temple University Hospital.

 has been a disease without a targeted treatment, leaving patients and clinicians to deal with a devastating disease course with no clear standard of care.

Caused by dysregulation of the alternative complement pathway, C3G often leads to progressive kidney failure, with many patients ultimately requiring transplantation—only to see the disease recur.

The US Food and Drug Administration approval of Novartis’ oral iptacopan (Fabhalta) for the treatment of adults with C3 glomerulopathy (C3G) marks a turning point in C3G care, offering the first FDA-approved drug for patients with the ultra-rare kidney disease.

The decision was based on data from the phase 3 APPEAR-C3G trial, where iptacopan met the primary endpoint of reducing 24-hour urine protein-to-creatinine ratio (UPCR) by 35.1% (95% CI, 13.8% to 51.1%; 

 = .0014), with sustained reductions at 12 months.

Additional analyses revealed use of iptacopan was associated with a higher proportion of patients meeting the composite renal endpoint—defined as a ≥50% UPCR reduction and ≤15% eGFR decline—occurring in 43.5% of iptacopan-treated patients versus 25.0% of those who switched from placebo at 6 months. A favorable effect on eGFR trajectory was also observed relative to historical trends.

Not only does this approval provide C3G patients with a treatment specifically designed to address the root cause of their disease, but it also opens the door for further advancements in complement-targeted therapies. With a new tool in their arsenal, clinicians can now offer patients a chance to slow or even stop disease progression—something that was once out of reach.

For additional insight into the significance of the approval and its impact on C3G care, the editorial team of 

 spoke with Gerald Appel, MD, a professor of clinical medicine, director of clinical nephrology, and director of the Glomerular Disease Center at Columbia University; Andrew Bomback, MD, an assistant professor of medicine at Columbia University Medical Center; and Jared Hassler, MD, a pathologist at the Temple University Hospital.

Expert Perspectives: Iptacopan FDA Approval for C3 Glomerulopathy

Relevant disclosures for Appel include Aurinia, Bristol Myers Squibb, Genentech, Genzyme-Sanofi, Eli Lilly, Merck, Pfizer, Mallinckrodt, Achillion, Alexion, Reata, Travere Therapeutics, GlaxoSmithKline, Vertex Therapeutics, Novartis, Apellis, Chinook, Arrowhead, Calliditas, and Vera. Relevant disclosures for Bomback include Amgen, Novartis, Kezar, Silence Therapeutics, Genentech, Visterra, Catalyst, Q32, and Apellis. Relevant disclosures for Hassler include Travere Therapeutics, Omeros, and Novartis.

Campbell P. FDA Approves Oral Iptacopan (Fabhalta) as First C3 Glomerulopathy Therapy. HCPLive. March 20, 2025. Accessed March 21, 2025. 

https://www.hcplive.com/view/fda-approves-oral-iptacopan-fabhalta-as-first-c3-glomerulopathy-therapy

A trio of nephrology experts discuss the significance of iptacopan’s FDA approval as the first treatment for C3G.

Jared Hassler, MD

Treatment Extension with Faricimab: Case Examples

Jennifer I. Lim, MD

PhD candidate at Greater Paris University Hospitals

Weisinger discussed findings from the largest cohort of patients with iTTP treated with Obinutuzumab.

Julia Weisinger, MD: Obinutuzumab a Promising Option for Intolerant/Refractory iTTP

Obinutuzumab was effective in treating patients with Immune-Mediated Thrombotic Thrombocytopenic Purpura (iTTP) intolerant or refractory to rituximab with an acceptable safety profile, offering a potential option for this patient population.

These findings, from the largest cohort of patients with iTTP receiving obinutuzumab, were presented at the

 66th American Society of Hematology (ASH) Annual Meeting and Exposition

, held December 7-10, 2024, in San Diego, California, by Julia Weisinger, MD, a PhD candidate at Greater Paris University Hospitals.

“There are not many clinical studies in TTP because it's a rare disease, and also, if there were some clinical studies, usually they were performed long ago, before the routine use of rituximab. So, we need new treatment options, and hopefully in the future, new guidelines what to use in TTP,” Weisinger told 

Weisinger and colleagues found that most patients (n = 51; 85%) reached an ADAMTS13 activity of at least 20% after treatment, 72% (n=43) reached a normal activity, and 15% (n=9) failed to improve ADAMTS13 activity. In 34 evaluable patients after obinutuzumab treatment, all had complete B-cell depletion within 2 months following treatment initiation. The investigators also found that patients with previous refractoriness to rituximab tended to have a higher risk of refractoriness (

= .052). There were no serious adverse events associated with obinutuzumab. After a median follow-up of 11 months (range, 1-44), 2 ADAMTS13 relapses and 1 clinical relapse occurred; 2 patients died: 1 patient had intracranial bleeding during a relapse of iTTP and another with a history of severe cardiac disease died in cardiac arrest.

This study is part of the TOLERATE project funded by the European Union under grant agreement #101072729.

Weisinger J, Fadlallah J, Barbet C, et al. Obinutuzumab in Rituximab Refractory or Intolerant Immune-Mediated Thrombotic Thrombocytopenic Purpura. Presented at: ASH Annual meeting; December 7-10; San Diego, California. Abstract 139.

Julia Weisinger, MD

Key Takeaways and Considerations for the Use of BTK Inhibitors in CSU Treatment

What are some key takeaways on the potential use of BTK inhibitors in the treatment of CSU that you’d like to share with clinicians managing this condition?

Panelists discuss how Bruton tyrosine kinase (BTK) inhibitors represent a promising new therapeutic class for chronic spontaneous urticaria (CSU) by offering rapid symptom control through targeted inhibition of both mast cell and B cell pathways, with newer agents like remibrutinib showing high selectivity, favorable safety, and robust efficacy in clinical trials that could position them as an important oral therapy option between antihistamines and biologics.

Mark Lebwohl, MD

 at the 2025 New Wave Dermatology Conference, Naveed Sami, MD, a board-certified dermatologist and professor of medicine for the UCF College of Medicine, discussed a variety of take-home messages from his “Cutaneous Effects of Immunotherapy” session.

In this particular interview segment, Sami was asked about ways to approach the diagnosis and differentiation of 

. Specifically, he was asked about differentiating them from other dermatologic conditions.

Differentiating Immunotherapy-Related Skin Reactions, with Naveed Sami, MD

“The approach is, number one, to have open communication with the oncologist, so that they have a patient and get them in as early as possible,” Sami explained. “...The second aspect is that we approach it the same as we would with any new dermatological condition that would present. A good history, was this present before, or have they had anything like this before? Then, even if they have, many conditions can look very similar at the very beginning. So a biopsy or using the tools that are necessary are crucial in terms of evaluating a patient [is important].”

Sami noted that such evaluations could include doing blood tests, especially if a patient has more of a hypersensitivity reaction, for example. If this is the case, Sami noted, then the appropriate blood tests for side effects, such as drug hypersensitivity syndrome, may be needed.

“There's a grading system, with grade one being mild, and it’s based on the body surface area involvement,” Sami said. “If it's less than 10%, it's grade one or mild. If it's between 10 and 30, it's moderate, and that's grade two. Anything greater than the body surface area of 30% is grade three, and grade four is life-threatening. So you're trying to first evaluate the grade of where the disease is presented, based on the symptoms and based on the grade.”

Sami noted that if a provider observes a grade 1 or early grade 2, as grade 2 has a wide range of 10% - 30%, then the treatment being used may be continued, potentially. Oral antihistamines over the counter and topical steroids, nonsteroidal ointments, can be used as much as possible to try to help with such symptoms, however.

“If that doesn't work for certain conditions where light treatment may be helpful, such as eczema, psoriasis, or lichen planus, we try to use non-systemic treatments, such as light treatment, to try to help prevent progression,” Sami explained. “If that is not beneficial, or if something is needed, it requires systemic treatment.”

To find out more about this session topic, view Sami’s full interview segment posted above.

The quotes used in this interview summary were edited for clarity.

During his New Wave Dermatology interview, Naveed Sami, MD, spoke about additional takeaways from his session on the cutaneous effects of immunotherapies.

Naveed Sami, MD, FAAD

Paul S. Yamauchi, MD, PhD, works as a clinical assistant professor at the David Geffen School of Medicine at UCLA’s Division of Dermatology.

New Findings on Tildrakizumab for Nail Psoriasis, with Paul Yamauchi, MD, PhD

American Academy of Dermatology (AAD) Annual Meeting

 demonstrated that tildrakizumab-asmn treatment led to significant improvements in 

 versus placebo, as well as a lack of new safety signals.

These data resulted from a study authored, in part, by Paul S. Yamauchi, MD, PhD, who works as a clinical assistant professor at the David Geffen School of Medicine at UCLA’s Division of Dermatology. Yamauchi spoke with HCPLive about his team’s findings on tildrakizumab and the study’s notable findings.

“So tildrakizumab was dosed at Week 0, Week 4, and every 12 weeks those patients on placebo were also given the placebo at Week 0, Week 4 and and Week 16,” Yamauchi said. “After Week 16, patients who were on tildrakizumab continued. Those patients on placebo were crossed over to receive tildrakizumab [at Week 28]. This was a 1-year study.”

Yamauchi highlighted several notable findings, including that participants demonstrated a significantly higher rate of 75% improvement from the point of baseline in their Nail Psoriasis Severity Index (mNAPSI 75) scores at the 28-week mark compared to those given a placebo. Specifically, it had been a 25.5% mNAPSI 75 response rate versus a 4.5% rate in the placebo arm (

Additionally, he highlighted that 29.4% of those treated with tildrakizumab were shown to have attained normal nails or nails that had minimal levels of psoriasis (ViSENPsO score of 0 or 1), as opposed to the 4.2% rate observed among those given the placebo (

Lastly, Yamauchi highlighted that the drug’s safety profile had shown consistency with that of the known profile of tildrakizumab. He highlighted a lack of serious adverse events linked to the drug’s use in the trial.

“It demonstrates very good efficacy to treat psoriasis, as well as convenient dosing every 3 months, which will enhance compliance,” Yamauchi said. “The efficacy of this drug is very good for plaque psoriasis and has an excellent safety profile, in that infections were the only 1 of the events that we're seeing in the clinical trials for tildrakizumab has no warnings about cancers or serious infections.”

This was the first study of an interleukin (IL)-23 inhibitor to assess the efficacy of such a drug in those with nail psoriasis. Additionally, effective and long-term medications for treating those with nail psoriasis are known to have been limited.

For more information on tildrakizumab’s results among patients with nail psoriasis, view the full video posted above. To learn more about data presented at AAD, view our 

The quotes contained in this interview were edited for clarity. Yamauchi has reported grants from Arcutis Biotherapeutics, Amgen, AbbVie, Lilly, Janssen, LEO Pharma, Pfizer, Regeneron, Sanofi, Dermavant, EPI Health, Novartis, Incyte, and Sun Pharma.

This interview with Yamauchi highlights phase 3b findings on tildrakizumab among patients with moderate-to-severe nail psoriasis.

Paul Yamauchi, MD, PhD

 You mentioned clinical data. Reggie, are you familiar with the published data, especially from the ICONIC trial, which allowed the FDA approval of these drugs for children with Alagille syndrome?

 I have some knowledge. I love the name of the trial. ICONIC sounds iconic. Interestingly, it’s one of what I call backward placebo-controlled trials. It’s a medication withdrawal trial—that’s the fancy name—where everybody up front received the drug openly, indifferent to the usual trial where half the patients get the drug up front and half don’t. In this one, everybody got it up front. Supposedly, this improves or diminishes the subjective bias of itching.

Patients received maralixibat 380 µg/kg once a day for 18 weeks. Half the patients were continued on therapy, and in the other half, the medicine was removed. No one knew who was in which group. That was done for 4 weeks. Then everybody got back on open label for an extended period of time, up to 48 weeks. That’s where the ICONIC trial stopped. There’s an ongoing long-term arm of this trial, but ICONIC stopped at 48 weeks.

The take-home message was that in the first 18 weeks of open label, their ItchRO [Itch Reported Outcome] score dropped by almost 2 points. One point is considered clinically important in validation of the ItchRO, so a drop in 2 points is quite significant. As you might have imagined, during the 2 to 4 weeks where the drug was withdrawn, the effect remained in those who continued on drug. But in those where the drug was withdrawn, their itch scores rose back to baseline, clearly suggesting that this medicine was helping the itch.

Furthermore, after everybody gets on open label again, even the patients on placebo get back on the drug, and their ItchRO scores improve. The differences in improvement during the open labels and placebo are pretty dramatic. If you look at these patients at a year out, about 80% of the patients experienced a greater than or equal to 20% reduction in serum bile acids. Serum bile acid reduction was correlated to improved pruritus.

The medicine showed not only improvement in itch but also improvement in the serum bile acids, which may be getting a little off topic or to the next topic. There’s a conversation about serum bile acids being a biomarker of liver outcome. If you lower your serum bile acids, you might get more bang for your buck. You might get rid of the pruritus, but you might also be able to improve or prevent progression of the liver disease, although that might be a question for another one of these conversations. That’s a summary of the efficacy data of ICONIC.

Of course, you have to talk about adverse events, which did happen. As you might imagine, the most common were GI [gastrointestinal] related. Vomiting, abdominal pain, and diarrhea occurred in 50%-plus of the patients on treatment. Fortunately, these adverse events rarely led to drug discontinuation. They were quite tolerable, so the vast majority of patients were able to complete the trial. In the ongoing long-term arm, that seems to be the norm.

 Reggie, thank you for very nicely summarizing it. The drug, of course, was maralixibat.

Regino Gonzalez-Peralta, MD, reviews clinical implications from the phase 2 ICONIC trial evaluating the use of maralixibat for the management of Alagille syndrome in pediatric patients.

Using Maralixibat for the Management of Pediatric ALGS

Regino P. Gonzalez-Peralta, MD

Sharon Fekrat, MD

To watch the video series component of this episode, click here.

1:35 Importance of early diagnosis of Alzheimer’s disease

05:48 The pathophysiology of Alzheimer’s disease

09:32 Screening for Alzheimer’s disease

21:37 Utility and practicality of PET scans

In this episode of MEDcast, expert geriatric psychiatrists explore the urgent need for effective diagnostic methods that can detect Alzheimer’s disease at an early stage. We will discuss blood-based biomarkers and other advancements that can help screen Alzheimer’s disease non-invasively and early in the disease course.

Authors