Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology, director of clinical research and patch testing, George Washington University School of Medicine and Health Sciences, discusses how small molecule inhibitors are used in atopic dermatitis, as well as why there is no one-size-fits approach to implementing them in practice.
As part of the Thursday Dermatology Program at the 2021 American College of Allergy, Asthma & Immunology Annual Scientific Meeting, Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology and director of clinical research and patch testing, George Washington University School of Medicine and Health Sciences, presented “Small Molecule Inhibitors,” part of the “Battle of the ‘Biologics’ by the Bayou” session.
Can you explain the use of small molecule inhibitors in atopic dermatitis and what novel findings your presentation addressed?
This presentation addressed small molecules in atopic dermatitis—really thinking about, in particular, the JAKs [Janus kinases], again, just because they are the ones that are furthest along—but really at a much more, almost philosophical or existential level. Thinking about who is the right patient for JAK inhibitors, and conceptually, should we be thinking about going broad or should we go targeted? Is it better to be going for an intracellular target or an extracellular target? And opportunities and considerations around dosing strategies and how do we choose between the different JAK inhibitors, as well as how long should we treat our patients with atopic dermatitis with JAK inhibitors. These are some of those high-level, I think, very clinically important questions that we addressed in the presentation.
How do small molecule and inhibitors work in atopic dermatitis?
Small molecule is a very broad terminology, and there are many different types of small molecules. Each that we think about would really depend on the specific mechanism, the specific type of small molecule. When we think about the JAK inhibitors, they're working by inhibiting the Janus kinases and blocking the signaling pathways that are mediated by the Janus kinases. There are other small molecules that are in development. There are some small molecules that may block the ability of our white blood cells, or lymphocytes, from going into the tissue and causing the inflammation in atopic dermatitis. And there are actually a couple of different ones that are in development now for atopic dermatitis that use that type of approach. Each one really has to be judged independently or separately. There's really no one-size-fits-all summation for all of them.