Mark Lebwohl, MD, Shares Updates on Recent Clinical Breakthroughs and Agents in the Pipeline

Abrocitinib, roflumilast, lebrikizumab, ritlecitinib, and bimekizumab—these are just a few of the therapeutic agents on the agenda to discuss at Winter Clinical Miami, held February 17-20, 2023, in Miami, Florida. The agenda focuses on the integration of new biologic treatment options for atopic dermatitis, recent breakthroughs in areas such as vitiligo and alopecia areata, and the next class of up and comers racing for FDA approval.

Mark Lebwohl, MD, dean of clinical therapeutics at Icahn School of Medicine at Mount Sinai and a co-founder of the Fall and Winter Clinical conferences, previewed the clinical pearls in a video interview with Dermatology Times®.

This transcript has been edited for clarity and length.

Dermatology Times: What can attendees expect to learn at Winter Clinical Miami?

Lebwohl: We're very excited about the Miami meeting. We had an enormous number of people sign up for it and, interesting to us, there was virtually no overlap with our other Winter Clinical meeting in Hawaii. I think the total number of people that [will attend] both meetings is 14, and we have a registration around 400. The last time I checked was weeks ago, and it was over 360 at that point, so we have a very good attendance and no overlap with our other meetings, which is exciting.

We have excellent speakers, a lot of new information to talk about. A lot of our colleagues are just getting used to the new biologics for atopic dermatitis like tralokinumab and dupilumab, which have really been breakthroughs in the treatment of atopic dermatitis.

There's a new one coming lebrikizumab and actually a couple of additional anti-IL 13 blockers coming as well so, just as we have in psoriasis [with] a significant number of biologics that are effective, we're seeing the same thing happen in atopic dermatitis. We have really good, really effective, and very safe drugs for atopic dermatitis.

Also, for atopic dermatitis, we have JAK inhibitors…so we've had abrocitinib and upadacitinib. Also, we have had tofacitinib, which is approved in psoriatic arthritis but works for other inflammatory skin diseases. We also, very recently, had approval of baricitinib for alopecia areata, and we have new drugs coming— ritlecitinib is coming hopefully for alopecia areata and I think we'll see exciting breakthroughs in inflammatory skin diseases.

Very interesting to many of us is that we have difficult cases that we've always had difficulty treating, and a lot of us would go to old drugs that have a lot of side effects like systemic steroids or cyclosporine or methotrexate. And then now that the JAK inhibitors came along, they're actually much safer than those 3 drugs, but they work for a lot of off-label conditions [where] we only have those 3 drugs so we're talking about sarcoid, granuloma annulare, connective tissue diseases like Sjögren's syndrome and lupus, and a whole host of other conditions that have been just very difficult to treat. We now have the JAK inhibitors, which seemed to work well for many of those conditions…cutaneous vasculitis. There are, again, some very good treatments for chronic urticaria, but when those don't work, it looks like the JAK inhibitors may play a role. Those are all very exciting.

We also have approved JAK inhibitors, and I would say [they are] better called the TYK2 [tyrosine kinase] inhibitors because [they don’t] have any of the box warnings and side effects of the JAK inhibitors…that's deucravacitnib for psoriasis, which is fairly new and we have a lot of new information coming out about it, a lot of new uses for it.

We also have a new drug coming, finally—bimekizumab, which we've been hearing about for several years. [It is a] phenomenally effective treatment for psoriasis and for psoriatic arthritis so we're excited about that, and many other new drugs in the field…Vitiligo, by the way, [and] ruxolitinib cream has been a major breakthrough, also approved for atopic dermatitis. Other non-steroid creams that have been breakthroughs and about which we have new information coming—including long-term information [and] durability of response information, what happens when you stop the drug and wait for it to recur, what's the recapture rate, stuff like that—we are hearing that about tapinarof and roflumilast creams. And of course, the other non-steroid I just mentioned is ruxolitinib cream so we'll hear a lot about those.

Even in the acne space, it's exciting that we have a new combination drug. You might say, ‘well, you know, we've had topical clindamycin for years, we've had topical retinoids like adapalene for years, and we've had benzoyl peroxide for decades, so what's new about the triple combination?’ The efficacy of combining those 3 in a single new preparation has been so dramatically better than any of the individual ingredients or even better than other combinations that it is completely surprising to us. The majority of patients are reaching efficacy levels that are phenomenal, so I think that that's a major breakthrough in topical therapy.

We have some drugs that are not that new but new enough; they're few years old yet haven't quite gotten as widespread use as we think they should, drugs like tirbanibulin for actinic keratosis. Again, a lot of new information coming out. There's a patient-reported outcomes study that will be presented for the first time at this meeting and that's very exciting to us. There's an antibiotic, which I use a lot, sarecycline, because it's so free of side effects, yet it hasn't—because of pricing issues, I think—been embraced by a lot of our colleagues.

Hopefully [attendees will] learn practical things at this meeting like how your patients can access those drugs without having to mortgage their homes. There are actually inexpensive pharmacies that offer major discounts [so] that the drugs are available at costs that’re even less than old generic drugs. I think that's going to be something that our colleagues will learn at this meeting that I'm very excited about. Then, there is a whole new cosmetic aspect to the meeting, which will usually take place in the afternoons, although other times during the meeting as well. For those who are interested in cosmetic dermatology, of which a large number of our attendees are, they will have a whole new cosmetic angle to the meeting that we have not had at Winter Clinical in Hawaii. I think that there are a lot of pieces to this meeting that should be appealing to many of our colleagues.

I will say, one of the classic emphases of our meetings is that we will teach you tips that you can use the day you return home, and that is something that this meeting is full of—things that you might not know that will make you a better doctor and will make your patients better off the day you return home.