Biologics for the Treatment of Adolescent Atopic Dermatitis - Episode 8
Julie Block: As I mentioned before, trigger management is one of the staples of managing atopic dermatitis. Adolescents need to learn on their own how to avoid their triggers. Skincare is a very big deal and that’s a transition. When you become a teen, you’re taking on more of your own self care of your skin. Let’s say you’re a young 13-year-old boy, you don’t necessarily want to be slathering your skin with a moisturizer 2 or 3 times a day head to toe. And mom isn’t controlling it anymore or dad isn’t controlling it, so sometimes those routines are not at their optimum for treating and managing the disease.
Elaine Siegfried, MD: I think that the thing that distinguishes disease in adolescents is that if you still have atopic dermatitis by the time you get to be a teenager, your chances of outgrowing it are going to be low. But the suffering that happens in children who are younger than 12 years old is the same or possibly even higher. Choices for adolescents are colored by lots of different things. Standard of care treatment for atopic dermatitis is topical therapy. Topical therapy is always thought to be safer, certainly is less expensive than the newer biologic treatments and it doesn’t require long-term laboratory monitoring. But topical treatment is a real burden. I always call it the tyranny of topical treatment. There are a lot of details to doing topical treatment, especially if you want it to work well. And teenagers have, especially teenagers who aren’t sleeping very well, who are impacted by their disease, they have very low tolerance for putting topical medication all over their whole body multiple times a day.
And so, most people don’t use enough medicine. A subset of people can’t even get the right medicine because of payer restrictions. Adherence is a big problem, and it’s the biggest problem I think in the adolescent population. They’re difficult.
Treating adults and adolescents for atopic dermatitis is very similar. The principles are the same. The tolerance of treatment for adolescents is probably a little trickier. Adults are more willing to be adherent to treatment. But I also think that there’s a subset of adults who have lived with their disease for such a long time that they are beyond even coming for healthcare. Adolescents tend probably to come a little bit more just because they still have their parents, and they also have insurance in many cases.
You know 50% of children in the United States are Medicaid insured. And then once you get to be 19 years old, then you don’t have that option anymore and that really cuts you off. In fact, yesterday I just saw a kid, he’s 18, he’s just about to be 19 and that’s kind of a crisis for him. He’s on an expensive biologic agent and he’s doing extraordinarily well. But the question is, what’s going to happen to him when he turns 19? Adolescents have more access to healthcare, and adults maybe a little bit less, it just depends on the adult. That’s one of the important parameters that sets that age group apart.
Well we just need a treatment that is usable, that doesn’t require 2 or 3 hours a day to achieve, that’s tolerable, and that’s affordable.
Julie Block: The unmet needs for adolescents are similar to that of adults—long-term control. Stop the itch, just stop the itch and let me sleep, and most people are going to be pretty happy with that outcome. Again, we don’t have treatments currently. The new biologic on the market is, as I said, looking quite favorable, and we’re very excited that that will bring the relief for patients who have been suffering their entire lives.
Physicians may wish to be more aggressive in treating children and adolescents with atopic dermatitis with the long-term goal of arresting the atopic march or the other comorbidities that come. We want to stop this as soon as possible because the longer a person has this disease, the more the impact of the disease and the comorbidities are in play. So, if we can shut down this immune response, this inflammation, we’re all going to be better off.