Treatment Efficacy in Atopic Dermatitis

Emma Guttman, MD, PhD, FAAD, presented her session, “Atopic Dermatitis (AD): Pushing the Boundaries of Treatment Efficacy,” at the 2023 AAD Annual Meeting and discussed the emergence of AD and its treatment efficacies. 

“AD is the most common skin disease in both children and adults,” Dr Guttman stated. Most people have mild AD, but 20% to 30% patients have moderate disease. 

AD is a heterogenous disease. Dr Guttman emphasized, “All AD subtypes share robust Th2 activation. But different AD phenotypes may require additional cytokine targeting.”

Next, Dr Guttman discussed AD emerging as a systemic disease. “Higher immune activation has been recently reported in peripheral blood from AD versus psoriasis patients,” she noted. “Several population-based studies showed increased cardiovascular disease in AD.”

Furthermore, she touched base on what’s in the pipeline for AD, “Dupilumab impacts both the inflammation and the barrier dysfunction of AD.” Tralokinumab and lebrikizumab target IL-13. “Is IL-13 inhibition enough to control AD, or do we need to inhibit both IL-4 and IL-13?” she asked.

Dr Guttman also introduced 0X40: a new target in AD. “OX40 is primarily expressed by activated T-cells and binds OX40L on antigens-presenting cells,” she indicated. “It also inhibits activated T-cells, including Th2 cells, inhibiting memory T-cells.”

Looking at oral medication, Dr Guttman mentioned Janus kinase inhibitors and presented results of the JADE mechanistic study of abrocitinib:

• Abrocitinib treatment for 12 weeks improved clinical signs and symptoms of AD
• No patients in the placebo group had a clinically meaningful improvement in clinical signs of AD
• Clinical efficacy was consistent with the broader phase 3 JADE clinical program

Regarding upadacitinib, she remarked, “Achieving higher levels of clearance and symptomatic relief for patients with AD may be possible—AD retreatment goals can evolve.”

Finally, Dr Guttman shared that the translational revolution in AD also extends to alopecia areata (AA). “Atopy has the highest comorbidity of AA and US studies show that IL-13 has the strongest association with AA,” she concluded.

Reference
Guttman E. Atopic dermatitis: pushing the boundaries of treatment efficacy. Presented at: AAD Annual Meeting; March 17–21, 2023; New Orleans, LA.