Notes on Dose Flexibility in Adult Atopic Dermatitis, with Raj Chovatiya, MD, PhD

In this interview conducted at the 2025 Revolutionizing Atopic Dermatitis (RAD) Conference in Nashville, Raj Chovatiya, MD, PhD, spoke about the most notable takeaways from his talk at the meeting titled ‘Dose Flexibility in Adult Atopic Dermatitis.’

Chovatiya is known for his role as a clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and as founder and director of the Center for Medical Dermatology and Immunology Research in Chicago. During this interview with HCPLive, Chovatiya was asked to explain what dose flexibility means in the context of atopic dermatitis treatment, and why it’s becoming more important in clinical practice.

“You know, one of the things that we've learned is that in the real world, patients oftentimes want their medications to fit around their life, especially based on their symptoms,” Chovatiya said. “We know that with a disease like atopic dermatitis, it can be waxing and waning, with flares, periods of quiescence, maybe even periods of remission. So the dream has always been a medication or a medication plan that can fit around where somebody is at.”

The way clinical trials are typically designed, Chovatiya explained, such research is usually based on continuous treatment with a topical, continuous oral medication use, continuous injections of a biologic, etc.

“But a combination of real-world data and even some of the unique designs on clinical trials have given us some insights in terms of how we might be able to change dosing from its traditional regimen,” Chovatiya explained. “I would say that the patients who tend to respond the best to therapies, ones that have control of their signs and symptoms, are definitely the ones that are most amenable to some degree of dose flexibility. Some of our biologics allow us to go down to every 4 weeks of dosing, or even every 8 weeks of dosing, if our patients are doing pretty good.”

Chovatiya noted his own view that if one’s patient is achieving significant levels of improvement within several months of treatment, then they can be considered for a dose change.

“In the case of oral medications, this isn't something that's been excessively studied in a clinical trial format,” Chovatiya said. “This is more in the real world and anecdotal evidence, but for people that have more seasonal disease, maybe during certain parts of the year, or people that are doing pretty well, they might be able to, potentially in an off-label format, use their medication to fit their disease.”

Chovatiya explained that for someone who may not report bad symptoms of atopic dermatitis year-round, they might use their systemic drug during only that part of the year.

“For somebody who otherwise has achieved really high end points in terms of itch clearance as far as skin, they might actually end up using the medication a little less frequently,” Chovatiya explained.

To learn more about this and other related topics, view the full interview video posted above. For more from RAD 2025, view our latest conference coverage.

The quotes used in this video summary were edited for the purposes of clarity.