Dr David Pariser Outlines Unmet Needs in Treatment Options for Atopic Dermatitis

The treatment landscape for atopic dermatitis is beginning to change from the use of topical therapies to biologics and more, said David Pariser, MD, senior physician at Pariser Dermatology Specialists and professor at Eastern Virginia Medical School Department of Dermatology.

The treatment landscape for atopic dermatitis is beginning to change from the use of topical therapies to biologics and more, said David Pariser, MD, senior physician at Pariser Dermatology Specialists and professor at Eastern Virginia Medical School Department of Dermatology.

Transcript

When it comes to treatment options for atopic dermatitis, what are the unmet needs? Where do we need to do a better job when treating this disease?

Traditional treatments for atopic dermatitis involve topical therapies with emollients, topical steroids, topical corticosteroids are the mainstay of treatment, various strengths and…forms of topical steroids or have utility in different ages of patients with different bodies areas. Systemic therapy within antihistamines…[are] greatly effective, can help…

Systemic drugs, such as systemic corticosteroids, and that includes prednisone or intramuscular injections, have traditionally been used, and are effective the problem is the side effects associated with those, you can’t continue those on a long-term basis… Immunosuppressants like cyclosporin, methotrexate, and mycophenolate mofetil have been used in the past.

But in the last couple of years, the treatment landscape has dramatically changed with the advent of dupilumab, the first and currently only a biologic agent available to treat atopic dermatitis, which has made a huge difference, and a huge improvement in the quality of life of patients, because of the control that it can have over their disease. But not everybody gets cleared up, not everybody even gets improvement—everybody gets some degree of improvement. Not everybody is going to be satisfied with that as a treatment option.

There's another biologic in the pipeline, which is probably going to be available the first part of next year: tralokinumab, which will be the second biologic. And then following after that are a number of the Janus kinase inhibitors—JAK inhibitors—oral drugs; 3 of which will be available for atopic dermatitis relatively soon. Two probably in the first half of next year. So, we will have even more treatment options for these patients.

When there are more biologics on the market, how do you expect treatment decisions will be made to decide between the options?

Oh, to answer that question of how the treatment decisions are going to be made between biologics, we really will need to wait for a couple of things. First is, although we do have some pretty final efficacy and safety data on tralokinumab, the next one, we don't have is what the access is going to be. And I am sure that as more of these drugs come online, there's going to be more interest in them both from patients and prescribers, and that the utilization of these will tend to want to increase.

So, the selection of one versus the other, it's going to be based on the medical factors—what is the comparative efficacy, safety, and as important or more important, what is the access going to be through what the health plan that the patient and third-party coverage?