Atopic Dermatitis Treatment Is Still More Trial and Error Than Personalized: Dr Emma Guttman-Yassky

While the future is bright with potential for personalized medicine to treat atopic dermatitis, current treatment is still more like trial and error, said Emma Guttman-Yassky, MD, PhD, FAAD, the Waldman Professor and System Chair of Dermatology and Immunology at the Icahn School of Medicine at Mount Sinai, the director of the Center for Excellence in Eczema and the Occupational Dermatitis Clinic, and director of the Laboratory for Inflammatory Skin Diseases.

As a result, it’s not uncommon to need to switch patients from one drug to another in the same class, she noted.

Transcript

Do we have reliable ways of knowing which patients with atopic dermatitis will respond best to which kinds of therapy?

I do think that the future probably is brighter in terms of personalized medicine and in doing more work to understand which drug for which patient, but we are not yet there. For now, I do think it's a little bit of a trial and error. For example, a patient that will not be controlled on Dupixent [dupilumab], we can try either another biologic or go directly for an oral medication that is a little bit more broad. We do see sometimes that a patient not responding to a Th2 antagonist, like dupilumab, may still respond—very similar to psoriasis—to another Th2 antagonists like an IL-13 antagonist. I think time will tell. We've seen it also with psoriasis, that different agents that target the same molecule work for one patient, but doesn't work on another patient or vice versa. And sometimes even switching within the class may work.

I think time will tell. If we can switch and which patients we can switch for the same class of drugs—only a different drug—or we need to switch them to something more broad. Like to take them from a biologic, like a dupilumab, to a JAK [Janus kinase] inhibitor. For example, in my clinic, if a patient fails a biologic, sometimes I am going to something more broad, because I don't want the patient to have another 3 or 4 months without help. Sometimes they need to get help immediately. You know, there are many considerations.