Andy Blauvelt, MD, MBA, president of Oregon Medical Research Center, discusses the use of systemic therapies vs biologics and why adherence is so important when treating patients with atopic dermatitis (AD).
Andy Blauvelt, MD, MBA, president of Oregon Medical Research Center, outlines his process for selecting which patients are best suited for which atopic dermatitis (AD) treatment.
How do you decide who is eligible for systemic therapy for AD?
Candidates for systemic therapy vs candidates for topical therapy is usually a decision that’s really important for us when we're seeing an AD patient and when we're seeing a psoriasis patient, and I use a number of different factors.
The first obvious one is the extent and severity of the disease. So, if someone has extensive AD, or very severe disease, it's obvious that they are candidates for systemic therapy. And then the other end of the spectrum, when it's obvious the AD is fairly limited, fairly mild, that patient’s going to be definitely a candidate for topical therapy.
I think in between are the hard cases. You have patients who are episodically bad, that is maybe a couple times a year. And historically, those patients have been treated with courses of prednisone, which I really don't like at all. And I'm more of a fan of using systemic therapy to prevent those episodic outbreaks in that type of patient.
I think another patient that emerges as a candidate for systemic therapy is one who has used topical therapy for many years and is frustrated by the level of control and the amount of disease that they have remaining. And instead of just keeping on doing the serial topical therapy and re-upping the 1-lb jar of triamcinolone, I think that's the type of patient who's also a candidate for systemic therapy; those who have been on topical therapy for a very long time and are frustrated by it and want something different.
Should patient adherence to other AD therapies play a role in deciding if biologics are the right choice?
Topical therapy, let's start with that. It's hard to do it every day like we want patients to do it, so I don't blame them. Instead of admonishing our patients for not using their topical therapy appropriately, you should recognize that they're not going to be doing that, and that may lead you towards more systemic therapy. We have oral options that are 1 pill once a day. That can be tough to do. And then you have biologics that tend to be a shot every 2 weeks, every 4 weeks, or so.
I think in a lot of ways, biologics can enhance or improve adherence, because it's only 2 times a month or once a month where they have to remember to do something.
We think of shots as inconvenient, but it actually is pretty convenient only to do something once or twice a month compared to doing something on a daily basis, so I do think biologics can help improve adherence with patients.