Taking the latest evidence of atopic dermatitis into practice

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This week, the American Academy of Dermatology Association’s Annual Meeting returns live and in person to Boston, and for the session, “Translating Evidence into Practice: Atopic Dermatitis Guidelines,” a quartet of experts focused on recent developments in atopic dermatitis (AD) and how they affect clinical practice.1 There have been promising Alzheimer’s treatments in the pipeline that have created buzz over the past few years and this pipeline is full of exciting new advances to to come.

Specific presentations were devoted to deciphering new associations and comorbidities; provide an understanding of the evidence behind new therapies, especially biologics; and showcasing clinical pearls that can slip between the cracks of evidence.

Jonathan I. Silverberg, MD, PhD, MPH, FAAD, Associate Professor of Dermatology at The George Washington University School of Medicine, Washington DC, kicked things off by discussing 2 big topics – an update from the lines AAD guidelines on AD comorbidities and multimorbidity concepts in addition.

Peter A. Lio, MD, FAAD, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Chicago, Illinois, followed with a lecture titled “On the Edge of Evidence.”

“My key message is that we should default to the highest level of evidence…but that size may not be right for everyone,” he said. “There is so much heterogeneity in our patients that until we can achieve something closer to precision or personalized medicine, sometimes we have to think outside the box. It doesn’t just mean doing something randomly. There are treatments and approaches that are at the borderline of evidence, which means that there is evidence that, by definition, is not of sufficient quality to be included in the conventional canon at this time, but which may still worth exploring.

As someone who sees a lot of patients with severe AD, Lio is confronted daily with patients who have failed everything and are therefore constantly looking for new approaches and therapies.

“I will say that some of the newer drugs such as dupilumab (Dupixent; Sanofi and Regeneron Pharmaceuticals, Inc), tralokinumab [Adbry; Leo Pharma]upadacitinib [Rinvoq; AbbVie Inc]abrocitinib [Cibinqo; Pfizer]and topical ruxolitinib [Opzelura; Incyte Dermatology] have all proven to be extremely helpful for some of my patients and I am grateful to have more options,” he said. “We have made incredible progress in [AD], but we still have many patients with unmet needs. I often say that I need all possible treatments.

During her talk, Lio discussed the importance of the skin barrier and how conventional moisturizers are essential, but also how sunflower oil, coconut oil and Oral hemp oil may provide additional benefits.

“I cover the microbiome and demystify, so to speak, the role of bleach baths, but I also talk about how things like coconut oil and a bacterial endolysin enzyme could play a role in the future,” he said. “I also talk about itching and how cannabinoids can be promising. Some of my favorite treatments cost little to no money and can be done at home without a prescription. Although these can almost never completely replace prescription drugs, they can often be used as a complementary therapy and I truly believe they can improve the quality of life for patients who are truly in pain.

There are challenges to overcome, Lio said, including unmet patient needs, drug costs and access to care. Also, some drugs have more adverse effects (AEs) and precautions that should be discussed with patients. All of these can be significant barriers to care, he said.

“I hope people come away with new ideas, an open mind, and a desire to keep pushing that ‘edge of proof,'” Lio said. “For the whole session, I think we really want to give a lot of general updates on AD, with a particular focus on new and emerging therapies and how best to think about them and use them in the practice.”

The third speaker in the presentation was Andrew Blauvelt, MD, FAAD, President of the Oregon Center for Medical Research, delivered a lecture titled “New Therapies” and focused on the many new drugs for AD that offer new choices to hopeful patients. for better support.

“I [review] data on new topicals for AD such as ruxolitinib, roflumilast [ARQ-151; Arcutis Biotherapeutics]and tapinarov [Dermavant Sciences],” he said. “I’m also [review] data on new systemic agents for AD—tralokinumab, lebrikizumab [Eli Lilly and Company]nemolizumab [Galderma]upadacitinib, abrocitinib and baricitinib [Olumiant; Eli Lilly and Incyte].”

As head of one of the leading dermatology clinical trial units in the United States, Blauvelt is well versed in new developments and issues that may arise.

“One should be aware of the safety issues associated with JAK inhibitors,” he said. “They should be used with caution in certain populations.”

The biggest challenge with these, Blauvelt noted, is encouraging doctors to use new drugs and getting them to patients when access is poor due to cost and insurance concerns.

Robert Sidbury, MD, MPH, FAAD, Division Chief of Dermatology at Seattle Children’s Hospital, concluded the session with a talk titled “The Rest of the Story,” where he covered additional developments in the AD space.

This article was originally published by sister publication Dermatology Times.

Reference

1. Sidbury R, ​​Blauvelt A, Lio PA, Silverberg JI. 2 Translating evidence into practice: guidelines on atopic dermatitis. Presented at the 2022 Annual Meeting of the American Academy Dermatology Association; March 25-29, 2022; Boston, MA.


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