Management of Type 2 Inflammation in Atopic Dermatitis - Episode 14
A broad look at the ongoing challenges and unmet needs in the field of atopic dermatitis management.
Peter A. Lio, MD: We have so many new treatments, so many new tools in our toolbox. Could there be any unmet needs left? I think there are, we still do have some unmet needs, and I’d love to talk about that now with you. When we think about atopic dermatitis in 2022, where do we have gaps in therapy or gaps in knowledge? What are you thinking about as the next big things to tackle?
Matt Feldman, MD: I think what you said, Dr Lio, toward the conclusion of our last section, about personalized medicine, we can try to use that patient in front of us as a living, breathing biomarker endotype, and try to surmise, based on their comorbidities or lack thereof, their prior response to therapies or lack thereof, what pathways are dominant in their disease state. But if we could somehow get their expression signature, what truly is overactive in their skin lesions, in their bodies, systemically, because as we know, this is not just an external-to-internal type of disease state. We’re talking about an inflammatory, internal-to-external disease state.
Can we get that heat map analysis on a patient-to-patient basis and block the right pathways in the most targeted way we can with the most efficacy and the least amount of potential unintended adverse effects? That would be the magic bullet, in my opinion. And I think we’re actually closer to that than we would think. I don’t think that’s pure science fiction at this point.
Neal Jain, MD: You make a great point. You think about the old Star Trek episodes where, they just did a little scan up and down, and right there you’d have your answer, and you just give them their injection or whatever it might be. But I agree, I don’t think we’re that far, with tape [stripping] studies, etc, being able to gene-chip and say, “Well, what’s overexpressed? What might be the right therapy?”
I think additional challenges that we certainly continue to have to deal with are evaluating our patients with skin of color, and with different racial and ethnic backgrounds. There’s still a lot of confusion and a lot of training that needs to be done. And unfortunately, these patients are often underrepresented in some of the studies that are performed, for a variety of reasons. Will we see similar therapeutic effects and benefits in these individuals? Are we really assessing and offering them access to these therapies in a way that’s meaningful to them?
Can we intervene early, and are these therapies all appropriate for younger children and our pediatric populations? And if we do intervene, can we have that disease-modifying effect? I think that’s an area that needs to be explored, and hopefully, our colleagues in the industry will hear that call and heed that call. so we do get the data to hopefully, again, impact the long-term outcomes of these patients.
Marc Serota, MD: I think there are significant unmet needs in the world of atopic dermatitis. I think understanding that this is a genetic condition, the holy grail would be modifying that genetic condition in some way, fixing the genes that create the skin proteins, like filaggrin, that are abnormal, which drives this process.
Another unmet need is intervening early. We don’t know yet, if we intervene by initiating systemic therapies in younger children who are showing atopic predilection, can we actually alter their disease course, so that they’re not going on to have adult forms of atopic dermatitis? We do have evidence that starting early allergy immunotherapy in these patients can alter their disease course, but we don’t yet know if we use some of these newer systemic agents to treat atopic dermatitis, does that augment their disease so that they don’t go on to have lifelong asthma?
Then within the treatment paradigm itself, we do have some unmet needs. Ideally, we would like to not have to give people shots if we can avoid it. We would like to dose people who are on oral therapies less frequently. We’d like to have therapies with improved safety and efficacy profiles wherever possible, and we want to get indications as young as possible because our youngest patients are some of the most severely affected by atopic dermatitis.
In the next 10 years or so, I hope we’ll continue to advance the therapeutics in atopic dermatitis and be able to fine-tune the systemic options that are the best for the patient.
Peter A. Lio, MD: I love the idea that, when we think about precision treatments, we often just say it’s the treatment that’s going to help the best in terms of their defect and get them better. But you brought it up, Dr Feldman, you said it. I think it’s so important, that it’s also going to be the safest treatment for them because precision medicine is not just about the best response, it’s about the safest drug too, and so we’re going to think about both sides of this, which is great.
The other piece, I think is, and I’m definitely not somebody who is afraid to spend health care dollars. I have sick patients who are complicated, and so I use expensive treatments all the time. But I’m still sensitive to it and sympathetic to the fact that not everybody has health insurance, not everybody has good health insurance. And sometimes even a number that we throw away, “It’s just a $30 moisturizer,” for some people, that’s the difference between making the rent that month. So I really want to see, how do we get more affordable care to people as well, because I think that’s a huge unmet need.
I get all these patients who are stuck, and sometimes especially if they’re on a government form of insurance and assistance, they can’t get the rebates and all the little freebies that we can use for other insured patients. I find that to be a huge problem that we also need to circumvent.
Transcript edited for clarity.