Improving Quality of Life in Atopic Dermatitis With Targeted Therapies - Episode 13
Aaron S. Farberg, MD, comments on use of different treatments for atopic dermatitis when a patient does not respond to treatment.
Linda Stein Gold, MD: Aaron, we have some other players now in the biologic realm. We have tralokinumab, which has been already FDA approved, and we have lebrikizumab, which is soon to be FDA approved. Can you comment a bit on what we expect from these?
Aaron S. Farberg, MD: As we all talked about, it’s a great time to have atopic dermatitis because we’re going to have more treatments coming down the pipeline. So lebrikizumab, which we’re not going to talk about in depth today just because it’s still being studied, and there are even a few more beyond that. But we cannot forget about tralokinumab, another very important first-line agent. It is an IL-13 [interleukin-13 inhibitor]. Again, when you look at the studies, it’s very efficacious, very safe. The important key part here is that not every drug is going to work for every patient, and so it is important to have these different options. As Matt has already discussed, dupilumab works great, but there are some adverse events. When those happen, what are we going to do? I need other options, and that’s where tralokinumab comes in. It’s another great option to have for us in treating these patients.
Linda Stein Gold, MD: Do you feel or are there data to show that if somebody doesn’t reach where they need to be or has an issue with dupilumab, that we shouldn’t consider something that is potentially an IL-13, or is that a viable option?
Aaron S. Farberg, MD: That’s a very important point. Obviously, these are different drugs, and they bind differently as well, even on the same molecules. It is important to recognize that if you do switch, you may get different efficacy. It’s not to say one is superior or inferior, it’s just that people are different, their diseases are different, and we need different treatment options. Another thing that Matt had mentioned is EASI-75 [75% reduction in the Eczema Area and Severity Index], and what about those higher numbers like EASI-90? Getting full clearance, I know we haven’t talked about it, but that really is our goal. That’s really what I want for our patients. I want an IGA [Investigator’s Global Assessment score] of 0.
I want it to be completely clear, not almost completely clear, but completely clear. Because not just in the eczema disease state but other disease states, what have we learned, what have we recognized? Sure, if you get them 75% clear, it’s going to have a huge impact on their life. You can have even more of an impact when you get them to 90%, or the holy grail, get them completely clear. As somebody with very significant allergies myself, you start to just live with these symptoms. You think, well, this is maybe as good as it’s going to get. Matt, I came into your office, I’m OK, I’m doing all right. But wait, I can get even more clear? I didn’t even realize how great that would feel. I can actually breathe now. So really pushing the next line of treatments, including utilizing a variety of the ones that we have now, sometimes even in combination, is very important.
Linda Stein Gold, MD: I want to give a realistic illustration of the difference between an EASI-75 and an EASI-90. One of the ways I like to explain it is, when you’re bad, as a moderate to severe patient, you can’t go to Macy’s and try on clothes. Because if you try on that white blouse, you’re going to bleed through and then you’re going to have to buy it because you bled on it. So you think about the fact that I can’t go do an activity that I would love to do. When you get to EASI-75, I can now go and try on clothes. I’m not going to bleed on them. I’m going to be able to go in the dressing room and be OK. But you get to an EASI-90, I can now put on a bathing suit and go out to the pool or the beach and nobody’s going to look at me funny and wonder what’s wrong with me.
Matthew Zirwas, MD: There was a series of about 28 patients from a European center who either had an inadequate response or an adverse effect from dupilumab and got transitioned to tralokinumab. If you did not respond adequately to dupilumab, there was a 50-50 chance you would respond adequately to tralokinumab. Now on the other hand, the red face that we sometimes see with dupilumab, that pretty much went away in everybody when they switched onto tralokinumab. The conjunctivitis, again, was kind of 50-50.
Linda Stein Gold, MD: We need those data. We keep encouraging them to please show us, tease out those data of patients who are in one similar category to the next.
Transcript edited for clarity