JAK inhibitors for the Management of Atopic Dermatitis (AD) - Episode 4
Eric Simpson, MD, MCR, reviews conventional topical and systemic therapy treatment options for the management of atopic dermatitis.
Linda Stein Gold, MD: Let's go on and talk a little bit about treatment considerations for the management of atopic dermatitis. Our treatment approach to atopic dermatitis has evolved over time. Overall, we need a 2-pronged approach. We need to be able to get those flares under control, but we also have to have a long-term game plan. Eric, can you talk to us about where we've come from? What are our traditional treatment options?
Eric Simpson, MD, MCR: I'll break it up into topical and systemic. In the topical space, over the years and through the IEC [International Eczema Council] guidelines and expert consensus recommendations, you approach a patient as a topical patient, and if they fail topical therapy or good regimen, then that identifies someone as needing systemic therapy. I tell my patients like that. Sometimes I've asked them, “Do you see yourself as someone who may be able to get control with topical therapy? Or do you think that you need something more than that?” I'm always surprised, and you get a sense of what they're interested in. Patients say, “No, I think I can do this topically,” or “No, it's not working for me over the last 20 years. Tell me what else is out there.” In the conventional treatments for topicals, topical steroids are the workhorse, but we're learning that it sometimes leads to adverse effects, especially with more moderate-to-severe diseases and depending on where you put the therapy, but topical steroids are cheap and they're highly effective. They just need to be carefully monitored and instruct to your patients to not overuse it and that's sometimes challenging. Then, we have a nice array of nonsteroidal treatments like the topical calcineurin inhibitors. We'll be talking about a new topical JAK inhibitor, as well as the topical phosphatase inhibitors such as crisaborole. We have some nice nonsteroidal that allows you to be an artist in terms of individualizing a plan for your patients on the topical side. Now, on the systemic side, the traditional treatments have been the traditional immunosuppressants that are not FDA [United States Food and Drug Administration]-approved for atopic dermatitis, but they have given us a way to treat patients before we had FDA-approved therapies. So, they still have a place. They're cheaper than the new therapies and some of them work quickly, like cyclosporine, and can be highly effective, but are not great long-term options. The drug survival for a lot of these traditional immunosuppressants are not that good, but they still play a role. I still prescribe them, but I'm prescribing them less and less as the new targeted therapy starts coming up.
Linda Stein Gold:, MD Yeah, that's great. We've had a lot of options in the past and we have a lot of newer options that we'll talk about subsequently.
Transcript Edited for Clarity