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Dr Robert Sidbury Reviews Novel Topical, Systemic Therapies for Pediatric Atopic Dermatitis


Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital, provides an overview of recent approvals and indications under consideration for the treatment of pediatric atopic dermatitis.

There are several nonsteroidal topical medications and systemic therapies that are either approved or under consideration for the treatment of pediatric atopic dermatitis (AD), said Robert Sidbury, MD, MPH, chief, Division of Dermatology, Seattle Children's Hospital.


Looking ahead, what are some novel therapeutic innovations in the management of pediatric AD?

In 2017—so new-ish—there was a new nonsteroidal agent called crisaborole that was approved for use in mild to moderate patients 2 years of age and older. Well, one thing that's newer than that still is the indication has gone down now to 3 months of age and older. So, how cool is that to have a nonsteroidal product that does not have any boxed warning associated with it, approved down to 3 months of age—that's when parents are most worried about using topical steroids on their kids. So to have this nonsteroidal option is a really nice new advance.

There's a new medication called ruxolitinib, which is topical, which was just approved in the last 6 months, which is a topical JAK [Janus kinase] inhibitor approved for kids 12 years of age and older—so, a little bit older—[with] mild to moderate AD. There are prohibitions of using any more than 60 grams a week or on a certain amount of surface area, so we need to be cognizant of how it's used, but really nice to have yet another nonsteroidal, topical agent approved for AD.

And then, not 1, not 2, but 3 new systemic medications approved. Two JAK inhibitors, oral agents, which are taken. One is called upadacitinib and one’s called abrocitinib—oral medications, once a day. Unbelievably encouraging efficacy numbers. Now it's a medication that's a little bit more broadly immunosuppressive than the biologics that we've talked about in the past like dupilumab. However, it’s less immunosuppressive than things like prednisone, cyclosporine, things that we've had in the past.

So, we're gonna have to be a little bit more cognizant of safety. There's going to be a fairly daunting boxed warning associated with those 2 JAK inhibitors, but a really nice option to have for the more severe end of the spectrum of our patient population. And then a medication called tralokinumab, which is another biologic.

So, I called 2017 “new-ish” before, well, dupilumab came out then as well, so I feel like that's been around longer than it has. It's really only been around since 2017. That's a biologic medication, which has been life-changing for so many of my patients since that time.

Originally approved for just adults, then down to 12, now down to 6 years of age, studies ongoing down to 6 months of age. So I wouldn't be surprised if in the next few months dupilumab is approved, probably not down to 6 months of age, just because there were only 11 patients in that study that were less than 2 years of age, but likely down to 2 years of age. So, really cool advancement with that medication.

Tralokinumab is another similar biologic medication, instead of blocking IL-4 [interleukin-4] and IL-13 signaling, it's IL-13 specifically. And, again, really exciting medication to have just to really expand the options, because whether it's insurance issues causing access for one or another medication, whether it's intolerance of a certain medication, or a medication just doesn't work for certain patient, instead of saying, ”Oh gosh, well, that's the only one we have other than prednisone.” Well, now that this biologic didn't work, let's try that JAK inhibitor.

Your child can't take shots. Well, here we now have an oral option. Blood draws are a problem, well, yeah, the oral options are nice, but you have to do blood draws. The shot, once a month, once every other week, no more than that—no blood draws. So, all of these things that we weigh when we decide the best medication for any one patient, but boy, what a lovely thing to have options.

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