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Mary is the associate editorial director for The American Journal of Managed Care® (AJMC®), The Center for Biosimilars®, and Evidence-Based Oncology™. She joined AJMC® in 2013 and oversees speaker recruitment and panel preparations for AJMC®'s premier annual oncology meeting, Patient-Centered Oncology Care®.

She has a BA in communications and philosophy from Loyola University New Orleans. You can connect with Mary on 

Articles

New data from the POLARIX STUDY show that substituting polatuzumab vedotin for 1 part of a classic first-line chemotherapy combination to manage diffuse large B-cell lymphoma improved progression-free survival without compromising health-related quality-of-life.


Additional Results From POLARIX Study Show Improved PFS With No Reduction in HRQOL

Jared is a freelance writer for The American Journal of Managed Care® (AJMC®), and previously worked as a senior editor for HCPLive® at MJH Life Sciences®.

He has an MA from University of Sioux Falls. You can connect with Jared on 

First steps include assembling equity data and reaching out to veterans’ advocacy groups.

Veterans Health Stakeholders Identify Priorities to Ensure Health Equity in Telehealth 

Rose is a freelance writer for The American Journal of Managed Care® (AJMC®), where she previously worked as an editor.

She has a BA in journalism & media studies and Spanish from Rutgers University. You can connect with Rose on 

A new study estimates that prescription of standard-of-care non–small-cell lung cancer (NSCLC) therapies is lower than expected in Medicaid programs, with significant variation between states. 

Targeted Therapies for NSCLC May Be Underused in Medicaid Programs, Study Suggests

Jaime is a freelance writer for The American Journal of Managed Care® (AJMC®), where she previously worked as an assistant editor.

She has a BA in print journalism from Penn State University. You can connect with Jaime on 

With most previous studies on ocular myasthenia gravis stemming from investigations the neurology field, the present investigators came to their conclusion via neuro-ophthalmic analysis.


Ocular MG Should Be Considered in Patients With Ptosis, Diplopia, Says Study 

The American Journal of Managed Care provides insights into the latest news and research in managed care across multimedia platforms.

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1rem

Compendium

 Atopic Dermatitis compendium is a comprehensive resource for clinical news and expert insights for the chronic skin condition that typically develops in early childhood.

A team of experts from the United States and Canada performed this systematic review, considering for the first time patient values and preferences for their atopic dermatitis (AD) care.

Guidance for AD Management Refreshed With New Recommendations

Following member surveys, expert interviews, and roundtable discussions, the American College of Allergy, Asthma, and Immunology (ACAAI) has released new recommendations for overcoming care disparities among those who have atopic dermatitis (AD) and food allergies.


ACAAI Report Highlights AD, Allergy Care Disparities and Proposed Solutions

Using data from the UK Biobank, potential correlations were investigated between excessive skin scarring outcomes arising from comorbidities among 230,000-plus European individuals.

Atopic Eczema Significantly Associated With Excessive Scarring in New UK Analysis

The parents of pediatric patients who have atopic dermatitis experience stress just as their children do, and this study investigated how that stress manifests among the parents, comparing outcomes between mothers and fathers.

Stress Management Important for Mothers of Pediatric Patients With Atopic Dermatitis 

For 2 important reasons—that brain cancer is so aggressive and its risk may be elevated in the presence of certain allergies—investigators of a meta-analysis set out to investigate potential connections between eczema and various brain cancers.


Eczema Exhibits Potential Protection Against Brain Cancer Development

Primary failures vs secondary failures for therapy, differences in pathophysiology across different ethnic groups, and adult-onset disease are 3 key topics that are either being investigated or warrant further study among patients with 

 (AD), said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento.

Are there any emerging research you find noteworthy in the management of AD and any gaps in knowledge that warrant further investigation?

In eczema, as well as other dermatologic conditions, we're starting to see better studies where we're looking at 2 things that I think are really important. One is we're starting to pay attention to what we call primary failures and secondary failures. So, with primary failures or nonresponders, these are patients that just never got better, for whatever reason, on a particular therapy, but that's very different from those patients that have done really well for 2 or 3 years and then suddenly stopped responding.

So, I think we've started to appreciate these subtypes within the eczema space, as well as other diseases where we're starting to understand the immune mechanisms that are driving why someone responds to a certain therapy and why people don't or why people lose effectiveness over time and what's driving that. And that's maybe going to ultimately open up this future of predicting response to a particular therapy before starting. So, that would really be a big advance in the treatment of inflammatory conditions.

Another area that I'd like to see more investigation, where we're again starting to have the conversation, is looking at disease in particular subtypes. So, certain ethnic groups' eczema may be a little bit different. So, there's this conversation about eczema in the Western population vs in Asian populations where maybe there's higher levels of IL-17 or other pathways that might be contributing.

I think adult onset vs childhood onset is quite interesting. We learned when I was in medical school and residency that eczema is primarily a disease of childhood. But I'm shocked at how many patients every day that I see who have actually never had disease as children who have true adult-onset disease. We need to understand this phenomenon, why at 50, 60, 70 years of life, they don't have this condition and yet develop it later in life. So, those are areas that I think really warrant further investigation and study so that we can start to tease out these subtypes of a condition we know is heterogeneous in terms of its presentation and also its immunology.

Videos

Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento, spoke on how clinical studies in atopic dermatitis (AD) are increasingly investigating topics that remain unknown for disease management, including primary vs secondary failures and AD pathophysiology across different ethnic groups.

Dr Jason Ezra Hawkes on Advances in Clinical Research and Gaps in Knowledge for Atopic Dermatitis

It is critical for dermatologists to educate patients on the disease course of 

 (AD) and understand how disease presentation may vary by skin color, said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento.

What considerations should be top of mind for dermatologists managing the care of diverse patients with AD, both in the pediatric and adult setting?

One need that we need to focus on is really centering our conversations on education about what the disease is and what the disease isn’t. So, especially with AD, it's highlighting this idea that they're dealing with a chronic condition in most cases, and that it goes through this very typical atopic march where we might see the development of other conditions. So, allergies, food allergies, sensitivity to latex or adhesives.


So, we start to see the disease change. They might have flexural disease when they're younger, and it sort of starts to evolve and presents differently in adulthood. So, I think education about the disease course and what to expect is really critical and we need to be driving that discussion. So, if there's expectations as to what this disease might look like over time, it's important to talk about how this condition impacts quality of life. For kids, for example, this is a huge sleep problem. It can also be an issue with school and how they interact socially. So, there can be a lot of stigma associated with these chronic conditions, eczema and both psoriasis and other skin conditions. So, we need to be considering that.

Having this conversation with patients that have seen multiple dermatologists or other providers, for example, it's shocking to me how many patients have not been told or don't understand the fact that they have a chronic skin condition. So, I think those are important points to kind of hit with patients.


And I think the other aspect I think about with managing conditions like eczema is that when treatments aren't working, sometimes we have to back up and rethink the diagnosis because there's a lot of mimics of eczema, for example. So, we need to be open to that. And the last point I'll make is about being maybe more open or less tied to particular therapies or conditions in skin of color, where presentations may be atypical.

This is true for AD where we can certainly see flexural disease, but sometimes for skin to color, we don't see the scale as well, we don't see the erythema. Sometimes there's a papular subtype of eczema that looks different from the typical plaques that we can see. And so we need to really kind of be open to some of these different subtypes and be a little more vigilant in diagnosing these conditions in skin of color.

Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento, discussed why it is important for dermatologists to educate patients on atopic dermatitis (AD) and keep an open mind on variations in disease presentation by skin color.

Population Health

Dr Jason Ezra Hawkes: Education on Chronic Nature, Subtypes of AD Key in Managing Diverse Patients

Clinical documentation is vital to address prior authorizations and other insurance requirements, such as step therapy, that can delay care and lead to worse outcomes among patients with 

 (AD), said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento.


Can you speak on the issue of delayed treatment in AD, particularly the impact of prior authorizations and other barriers to treatment caused by insurance requirements in the management of patients?

The impact of prior authorizations, insurance requirements, it's really not a unique problem to dermatology or even AD, but it's gotten a lot worse. So, we're seeing more roadblocks and barriers to care. Step therapy, in my opinion, is an insurance strategy to really delay care for using specific medications, which I think is a strategy to lower costs for insurance providers, but sometimes that's at the expense of safety.

, which are highly effective, very safe, but insurers are requiring patients to go through methotrexate, cyclosporine—these are off-label therapies, and they can have significant side effects. So, this is a problem. We're seeing legislation work against these step therapy requirements so that we can get patients more quickly to more effective therapies.

I think cost is a barrier that we need to be sensitive to. And we also need to be aware of the programs that are available for patients—co-pay programs, patient assistance programs. I think the pharmaceutical industry has been very generous in these programs that try to help our patients who don't have insurance plans that make these treatments affordable.

But I think there's also a burden on physicians, it's not out of our control entirely. And I say that in part because our documentation and our clinical notes are absolutely critical. It might be even the vast majority of the battle to get certain therapies approved. I see many patients who are sent for second or third opinions who couldn't get approved for medications. Writing a detailed note with prior therapies, the duration of therapy, side effects, contraindications to other therapies, we can often get medications approved.

So, we also have to do our part by making strong cases in our clinical documentation. And that's been challenging as health care systems have pushed us to see more patients at shorter intervals. So, the documentation I think has dropped off, gotten a little poorer over time, which is working against us in trying to get the prior authorization approval that we want for certain therapies.

Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento, discussed how prior authorizations and other insurance requirements are limiting treatment access in atopic dermatitis and how dermatologists can help ameliorate these approval issues.

Dr Jason Ezra Hawkes on Prior Authorization, Clinical Documentation Issues Limiting Atopic Dermatitis Treatment Access

There has been extensive advancement in immunotherapy for the treatment of 

 (AD), but unmet needs persist to manage disease burden in patients with more broadly mediated immune disease and to address uptake issues, particularly for pediatric populations, said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento.

How would you describe the current use of immune therapies in AD, and what further growth would you like to see whether in treatment advancements or addressing uptake issues?

We've had huge advances in AD, and that's really helped a lot of patients. So, again, blocking out IL-13 [interleukin-13] with biologics has been a very highly effective strategy with very low safety concerns. But we're starting to see those other groups of patients, again, who aren't responding that we're looking at other therapies. So, the JAK [Janus kinase] inhibitors, for example, may actually help us in covering those patients who don't really respond to targeted therapy.


One of the pros and cons to biologics, for example, is that they're very targeted therapies, they're very specific. And sometimes we see with patients with AD that they have a messier immune disease, they have multiple pathways that are involved in the presentation of their skin condition. So, we may need therapies that act a little bit broader.

We really don't know the safety of these newer medications; the JAK inhibitors, as they come out, for example, we're still learning and that will take some time. And I think in this way, we have to sort of anticipate that there may be problems or there may be concerns or reservations for our patients. I think the pediatric population is a group that's particularly difficult because sometimes they can't use pills or they're unwilling to do shots. And so this can limit some of the uptake of these medications.


So, we need to continue to develop therapies that are safe, that can be applied to a wide range of patients, because a lot of the therapies we have right now really can't be applied to a lot of our pediatric patients, or families or parents may be unwilling to pursue these therapies that are highly effective due to concern.

Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento, discussed recent advancements in immunotherapy for atopic dermatitis and what unmet needs persist to address uptake issues and patient-specific care needs.

Dr Jason Ezra Hawkes Addresses Immunotherapy Innovation, Uptake Issues in Atopic Dermatitis

 (AD) with biologic therapy requires shared decision-making between the dermatologist and patient to ensure that the pros and cons of each therapy are known and the right drug is given, said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of Dermatology at the University of California Davis in Sacramento

Can you discuss factors to consider in recommending biologic treatment for a patient with AD, whether as monotherapy or in combination with other medications?

When I think about biologics, I'm thinking about the severity of the patient. We were trying simpler things for maybe more localized disease or mild disease, but we need to sort of up our game in terms of treatment and management strategies as disease worsens. And so dupilumab was really a game changer for the treatment of AD, because it was so effective in so many patients, and the tolerability was actually very, very good.

So, I really rarely see lack of effectiveness or issues with tolerability with dupilumab, for example. So, it's been a big success for a lot of patients and we've seen other biologics that are coming out, specifically those that just block IL-13, for example, rather than IL-4 and IL-13. That also shows promise, but, as mentioned, these therapies don't always work for every patient. Some patients aren't responders, or it’s not covered by insurance, or they're afraid of injections. So, we also have to think about other strategies. Sometimes we have to use some of the oral medications or phototherapy; methotrexate or cyclosporine, for example, are sometimes required.

So, when we start thinking about these therapies, we want to have that shared decision-making conversation with patients and talk about the pros and cons. And most of the time, I'd say with biologics, we will sort of stick with monotherapy because it works for most patients. But occasionally, we need to add on other therapies like topical steroids, as I mentioned, methotrexate, which can be used safely with dupilumab, for example.

We're starting to see new therapies populate this space. Janus kinase (JAK) inhibitors are a class that'll be very exciting for this area, but it will also have its pros and cons. So, again, I think it comes back to having that shared decision-making conversation with our patients, so that they really understand what the ups and downs of the therapies are, but more importantly, we want to make sure that we ultimately find that therapy that alleviates the burden of this disease on our patients.

Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of dermatology at the University of California Davis in Sacramento, spoke on the importance of shared decision-making in deciding which biologic would best alleviate disease burden in patients with moderate to severe atopic dermatitis.