Upadacitinib, Long-Term Control, and Tapinarof, Oh My!

At the 2023 Revolutionizing Atopic Dermatitis (RAD) conference in Washington, DC, presenter Raj Chovatiya, MD, PhD, assistant professor of dermatology at the Northwestern University Feinberg School of Medicine and a Dermatology Times® Editorial Advisory Board member, presented 3 sessions on his treatment pearls for managing atopic dermatitis.

During Chovatiya’s first session, “Advancing Therapeutic Options,” he reviewed late-breaking updates on upadacitinib, a JAK1 inhibitor for patients with moderate-to-severe atopic dermatitis. In his next session, “What is the Evidence for Long-Term Control With Current Therapies,” Chovatiya discussed how some targeted topical therapies, biologics, and oral JAK inhibitors may help patients achieve long-term control. Finally, in his last session, Chovatiya presented late-breaking data on tapinarof cream 1% for the treatment of extensive atopic dermatitis in adolescents and children.

Transcript

Raj Chovatiya, MD, PhD: Hi there, my name is Dr. Raj Chovatiya. I’m an assistant professor of dermatology at the Northwestern University Feinberg School of Medicine and a member of the Editorial Advisory Board for Dermatology Times.

Dermatology Times: What are a few of the important clinical data points from your first RAD session, "Advancing Therapeutic Options?"

Chovatiya: In one of the first talks that I kicked things off at RAD, we talked about some late breaking updates on upadacitinib, that JAK1 inhibitor we think about for our moderate to severe atopic dermatitis patients. Now, I can't say that it's a new therapy; we've had at least about a year plus of experience and a chance to really use it in the real world. But, we're seeing some new emerging data to give us some clues on best practices in the real world. So, some of the newer data that was introduced during this point in time, was talking a little bit about later updates and safety, and then putting this in context in terms of the real world when it comes to our atopic dermatitis patients. And really going through that process of thinking about how you identify the right patient for therapy.

Dermatology Times: What are a few key highlights from your session, "What is the Evidence for Long-Term Control With Current Therapies?"

Chovatiya: A big question that's rattling around in everyone's brain when it comes to atopic dermatitis is control. Now, with the word like control, it can mean so many different things to so many different folks. But basically, our patients are looking for therapies that work and keep working in the long run, and can really suppress whatever they identify as their disease activity or flares. So, we won't really argue about the definition here. But I had a lot of fun talking about a lot of the therapies that we've come to know and love over the past few years and thinking about how exactly they're used when it comes to long term control.

So, I first touched on some of our targeted topical therapies, crisaborole and topical ruxolitinib cream. In both cases, we talked about top line efficacy, we talked about some of the longer-term data we have, and the fact that it looks like potentially there might be some ability in the case of crisaborole to proactively use this in the real world. And in the case of topical ruxolitinib, perhaps when things are under control, not having to use it every single day, or rather, maintaining some degree of flexibility. The next thing we talked about was our biologic options: dupilumab and tralokinumab. We touched on some of the same facets, and in this case, we talked a little bit about the fact that it looks like in both cases, you may not necessarily need to keep with the initial dosing regimen to keep that long control over the long-term period. Finally, we touched on the oral JAK inhibitors: abrocitinib and upadacitinib, again, the same topics in terms of efficacy and what things look like over one year, two years plus. But the interesting thing about these medications is even though we think about them as really fast acting, it looks like that for people that don't necessarily get control early on, if you managed to keep them on therapy or potentially bump up that dose, you can actually get them under control, eventually. So, it does behoove us to think about treatment in terms of a chronic paradigm. Bottom line, there's an embarrassment of riches when it comes to our therapeutic options and atopic dermatitis. There's going to be even more coming, but really some exciting data when it comes to thinking about what we can do for our patients in the long run.

Dermatology Times: What are the main takeaway points from your late-breaker session on tapinarof cream 1% for extensive AD in children and adolescents?

Chovatiya: One of the more exciting breakthroughs we've seen actually outside of atopic dermatitis in the past year has come in topical psoriasis therapy, and in particular, nonsteroidals. Something I didn't think I'd be saying for quite a while just because we haven't seen much activity in that space. One of those medications that came to us for use in the therapeutic setting was tapinarof cream. Now tapinarof cream was also being studied for atopic dermatitis and I had the opportunity to present some late breaking data when it came to a maximum use study in adolescents and children with atopic dermatitis. And we think about a maximum use study, you're talking about people with a high burden of disease and a really high body surface area. So, in this case, we're talking about 25% to 35% plus some people as high as 90%. And essentially the goal of these studies is if you use the medication over a large body surface area, what happens? We found out that there was very, very low systemic absorption. Medication itself was very, very well tolerated as well, 2 things that we really need to know about when it comes to thinking about safety in the real world. Bottom line, really promising data looking forward when it comes to tapinarof cream for atopic dermatitis across a variety of age groups.

[Transcript edited for clarity]