Optimizing Treatment of Pediatric Atopic Dermatitis - Episode 17
Amy Paller, MD: Treating atopic dermatitis always is the trickle down from treating adult atopic dermatitis. There are many agents now in the pipeline, both topical and systemic, that are being developed for adults and also starting to be looked at for children. We've got, in the topical arena, the topical JAK inhibitors, which are looking quite good as a new nonsteroidal substitute. We also have a new drug called tapinarof, the first of the TAMA [therapeutic aryl hydrocarbon receptor modulating agent] group of potential agents for atopic dermatitis. That is another nonsteroid for atopic dermatitis.
In the systemic medication categories, we have 2 groups. We have the monoclonal antibodies and we have the JAK inhibitors that are primarily being looked at. We can think about the other monoclonal antibodies. We know that there are 2 inhibitors of interleukin-13 that are in development. One is lebrikizumab and the other is tralokinumab. These are both targeting what is the primary ligand in atopic dermatitis for the IL-4 [interleukin-4] receptor, and are looking quite good in clinical trials.
We'll see how the phase 3 trials come out over time with these. But these are all moving into, at least, the adolescent age group in terms of investigation. And then there are others among the monoclonal antibodies that are in development. Some of them have fallen off because in adults they didn't look like they were doing what was hoped for. But others are still in the running, and we'll see how that goes. The other major area of interest is the JAK inhibitors. And systemically, when administered, they look amazing in terms of their efficacy.
They'll certainly rival dupilumab for efficacy. However, there are still concerns about safety in these. And I think that that will delay their being available for children for a while, or at least as first-line agents. We know that the studies so far in atopic dermatitis look very clean. We really haven't seen some of the concerns. However, there will be a black box warning on this group of systemics that are the JAK inhibitors.
And if anything comes out, for example, venous thrombosis, or significant other issues, then I think we're going to be stepping back a little. But we know that there can be some minor issues. For example, a little bit more acne, or some increase in lipids, or some increases in creatine kinase. But if the profile overall looks good, without issues like thrombosis, then I think we'll have to still give it a little bit of time before we feel great safety for them, especially going down into the pre-adolescent years.
Moderate to server atopic dermatitis is a huge problem for children who are affected, as well as their families. So many of our children continue for years and years on potent corticosteroids once or even twice daily, just to obtain some modicum of control that makes their lives a little bit better. We've only had systemic agents that are immunosuppressives and have a lot of potential adverse effects, require regular laboratory tests, and require a lot of attention with concerns about long-term safety.
I am hoping that as we have dupilumab and other new systemics available that work well for these children, we'll be able to substitute these years and years of potent topical corticosteroids with these systemic agents that often do so much better a job at controlling the atopic dermatitis and improving their lives.
Transcript Edited for Clarity