Top Insights From 6 Influential Leaders in AD

The summer conference spotlighting atopic dermatitis (AD) late-breakers and insights transitioned from Revolutionizing Atopic Dermatitis (RAD) to Revolutionizing Alopecia Areata, Vitiligo, and Eczema (RAVE) in Chicago, Illinois, this year. Six AD management and research leaders shared dozens of pearls to equip dermatology clinicians with the latest treatment advancements, guideline updates, and more.

Raj Chovatiya, MD, PhD, MSCI

Raj Chovatiya, MD, PhD, MSCI, clinical associate professor at the Rosalind Franklin University of Medicine and Science’s Chicago Medical School in Illinois, founder and director of the Center for Medical Dermatology and Immunology Research in Chicago, and Dermatology Times’ 2024 Fall Editor in Chief, highlighted the progress in treating itch in AD and explored the potential for current therapeutics to achieve remission. Chovatiya emphasized that itch is a major concern for patients with AD and noted that recent advances allow for better measurement and treatment. He discussed how biologics like dupilumab (Dupixent) and tralokinumab (Adbry) show early and sustained responses, with tralokinumab possibly taking longer to reach maximum efficacy. Oral JAK inhibitors provide high and sustained itch relief, whereas topical ruxolitinib (Opzelura) offers rapid and profound responses.

Chovatiya also examined the possibility of remission with current therapies. He reviewed long-term data to assess whether reduced or absent dosing could indicate remission. “Bottom line, probably not,” he said, but he expressed optimism that future therapies might achieve this goal, indicating that ongoing research could lead to breakthroughs in disease modification and remission.

Robert Sidbury, MD

Robert Sidbury, MD, division chief of dermatology at Seattle Children’s Hospital in Washington and co-chair of the American Academy of Dermatology’s (AAD) AD Guideline Workgroup, reviewed changes in the AAD’s recent guidelines and compared them to those of other organizations like the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology. “Dupilumab was the first systemic FDA-approved treatment for atopic dermatitis that’s not prednisone, and it was approved in 2017,” Sidbury noted, highlighting the extensive global guideline updates due to new medications.

Sidbury emphasized key differences between the AAD’s guidelines and the joint allergy guidelines, attributing them to the inclusion of patient representatives in the latter. “That led to some deviations from a pure assessment of the evidence on certain drugs,” he said, explaining how patient perceptions influenced recommendations. Differences included the benefit of bleach baths and the use of systemic agents like methotrexate and azathioprine.

Looking ahead, Sidbury expressed excitement about upcoming therapeutics like lebrikizumab (Ebglyss), nemolizumab (Mitchga), and OX40 inhibitors, stating, “There’s a list of potential things coming down the pike, which I’m really excited to hear about the latest and the greatest updates.”

David Rosmarin, MD

David Rosmarin, MD, chair of the department of dermatology at Indiana University School of Medicine in Indianapolis, expressed enthusiasm for new therapeutics in the AD pipeline that directly target the STAT pathway and the STAT transcription factor. “There’s also a strategy of degrading the STAT protein, which can also hopefully give us JAK-like efficacy, great selectivity, and hopefully improve safety,” Rosmarin noted. He highlighted the potential of silencing RNA targeting JAK inhibitors or the JAK protein, which could lead to new topical or injectable treatments. “With silencing RNA, you can also perhaps achieve good selectivity, and that may form the basis for new topical or injectable,” he explained. Rosmarin also showed interest in anti–IL-22 and anti–IL-18 agonists, emphasizing that these would provide additional treatment options for clinicians dedicated to managing AD, offering patients more targeted and effective therapies.

Amy Paller, MD

Amy Paller, MD, professor and chair of the department of dermatology at Northwestern Feinberg School of Medicine in Chicago, Illinois, discussed current and upcoming treatments for pediatric AD. “For most of our patients, topical steroids remain the mainstay of treatment,” Paller noted, but she emphasized the need for nonsteroidal alternatives, especially when parents are nervous. She expressed enthusiasm for new nonsteroidal topicals like tapinarof cream (Vtama) and roflumilast cream (Zoryve), both approved by the FDA for treating psoriasis, and anticipated a future decrease in the age indication for ruxolitinib (Opzelura) to benefit younger patients with AD.

Paller highlighted the challenges with administering dupilumab, approved for children as young as 2 years, due to the difficulty of at-home injections. She stressed understanding family comfort levels and offering tips for less painful administration. New biologics like tralokinumab and lebrikizumab are promising for adolescent patients.

Regarding JAK inhibitors, Paller mentioned the ongoing trials for younger children and their potential as an oral alternative. “So far, we have very good safety,” she said, referring to abrocitinib and upadacitinib being approved for children down to 12 years.

Paller underscored safety and long-term effects as key considerations in treating pediatric AD. She observed promising results with dupilumab, noting, “Many of our pediatric patients after a year or two are doing so well that we’re able to just taper...we’re starting to think a little bit more about the concept of remission.”

Melinda Gooderham, MD, MSc, FRCPC

Melinda Gooderham, MD, MSc, FRCPC, medical director at the SKiN Centre for Dermatology in Peterborough, Ontario, Canada, discussed emerging biologics targeting IL-22, IL-33, and OX40 for AD. Gooderham highlighted current and upcoming therapies focusing on IL-4, IL-13, and IL-31, and explored new areas involving both innate and adaptive immune targets. “For the innate, we’ll be talking about some of the alarmins that have been targeted, TSLP [thymic stromal lymphopoietin], IL-33 and its receptor, as well as OX40, OX40 ligand, and IL-22 and its receptor that has also been explored for atopic dermatitis,” she explained.

Gooderham also discussed modifying regulatory T cells to enhance skin immunobalance. She emphasized learning from failed targets and focusing on promising ones with potential for remission or disease modification. “With the OX40 and OX40 ligand and the T regulatory agents, there seems to be a duration of response,” she noted, adding that patients maintain clear skin for weeks to months post therapy. This potential for long-term efficacy could significantly benefit patients seeking treatment holidays or long-term cessation while maintaining their response.

Jonathan Silverberg, MD, PhD, MPH

Jonathan Silverberg, MD, PhD, MPH, RAD conference chair and a professor at the George Washington University School of Medicine and Health Sciences in Washington, DC, emphasized the prevalence of autoimmune comorbidities in patients with AD. “The whole spectrum of autoimmune disease shows up at high rates in patients with AD,” he said, highlighting the need for dermatologists to consider these alongside allergic comorbidities.

Silverberg focused on common comorbidities like rheumatoid arthritis and inflammatory bowel disease, which have their own approved therapies. He also discussed the potential of AD therapeutics to worsen autoimmune conditions. “The strength of these medications is how precise they are.... The weakness...is how targeted they are,” he explained, noting the risk of shifting immune responses and exacerbating autoimmune issues.

He advised considering treatments that address both AD and autoimmune disorders or using combination therapies, despite the cost and complexity. “This becomes a very important consideration in this patient subset,” Silverberg concluded.