New and Promising Drugs in Inflammatory Dermatoses

As part of the first day of sessions at the Society of Dermatology Physician Assistants (SDPA) Annual Summer Dermatology Conference in Boston, Massachusetts, Mark Lebwohl, MD, presented his session, "Inflammatory Dermatoses: A Case-Based Review," alongside co-presenter, Darrell Rigel, MD, MS.

Lebwohl, a Dermatology Times® editorial advisory board member, dean for clinical therapeutics at the Icahn School of Medicine at Mount Sinai, and chairman emeritus of the dermatology department at Mount Sinai, sat down with Dermatology Times to discuss the key highlights of his session.

Mark Lebwohl, MD: Hi, my name is Mark Lebwohl, and I am the dean for clinical therapeutics at the Icahn School of Medicine at Mount Sinai. I'm also chairman emeritus of the dermatology department at Mount Sinai. And I am very pleased to be speaking at the SDPA on incredibly exciting changes in inflammatory skin diseases. There have been many, many new approvals, and several new ones coming in the very near future, for new treatments for psoriasis, atopic dermatitis, alopecia areata, and vitiligo. So it's really an exciting time in dermatology, and the treatments that have come out have really enabled us to treat our patients better.

I'm starting out speaking about topical therapies, of which we have 3 new, exciting agents. One of them is called roflumilast cream, which is a PDE-4 inhibitor for psoriasis, but also has some evidence showing efficacy in psoriasis.

Next, I'll be speaking about tapinarof cream. Also, it is an Aryl-hydrocarbon hydroxylase topical therapy agonist that is highly effective for psoriasis and also for atopic dermatitis. So those 2 are non-steroids that have really enabled us to treat patients, even in steroid-sensitive sites like the face and intrusionous areas with a non-steroid with a high degree of efficacy.

And then the third topical I'm going to be speaking about is ruxolitinib cream, which is approved for atopic dermatitis and for vitiligo, the first topical therapy we have approved for vitiligo ever, and it is quite effective. And I make the point that it is gradually effective; it takes a while to see high degrees of efficacy, where we really recommend people to the point where the vitiligo becomes a bad memory, and that may take a year or even longer, but I show in the talk that that ruxolitinib is indeed effective.

Then I move on to oral agents, and specifically deucravacitinib, which has been approved for the treatment of psoriasis, and it's a new oral agent, very safe, highly effective.

In the realm of injectable treatments, we have an exciting new treatment coming out very soon for atopic dermatitis. We've seen the phase 3 results, and they are as good as any biologic out there for atopic dermatitis. It's an antibody to IL-13. It does have a side effect of conjunctivitis, similar to the other antibodies to IL-4 and IL-13.

And then we also have a new injectable coming out for psoriasis, namely bemekizumab. We've been waiting for that drug for a long time. It blocks IL-17A, which ixekizumab and secukinumab also block, but it also blocks IL-17F. And by blocking both, we seem to get an additive effect, so that we get more benefit with the bemekizumab. Very exciting new treatment; also exciting for psoriatic arthritis.

And last but not least, there are 2 drugs on the horizon for generalized pustular psoriasis, and the one that is already on the market and approved recently is spesolimab. It is an antibody to the IL-36 receptor, and it results in very rapid, profound improvements in this life-threatening disease, which we now finally can treat. There is some data and imsidolimab, which also works by the same mechanism, but it is still a little bit of ways before approval.

We also have a couple of new drugs coming out for vitiligo and for alopecia areata. Baricitinib is approved for alopecia areata—the first treatment we've ever had approved for alopecia areata. And there will be other JAK inhibitors along the way, including ritlecitinib, which hopefully will be coming out soon. We also have JAK inhibitors orally, like riltecitinib coming out for vitiligo, and currently undergoing testing for vitiligo. So it's an exciting time in dermatology, and we can now take care of conditions which have been very difficult to treat for many years, and we also will be able to treat some of the conditions for which we've had treatments, but now we have treatments that work a little better or a little safer. Thank you.

[Transcript edited for clarity]