Utilizing the Treatment Landscape for Moderate to Severe Atopic Dermatitis

Since the approval of dupilumab in 2017, the landscape for targeted therapies for the treatment of moderatetosevere atopic dermatitis (AD) has widened. The evolution of AD treatment, case studies, and best clinical practices were discussed in the recent Dermatology Times® Around the Practice® custom video program titled “Atopic Dermatitis First-Line Treatment Options: Systemic Therapies for Moderate to Severe Atopic Dermatitis.”¹

The series was moderated by Jonathan Silverberg, MD, PhD, MPH. He was joined by Brad Glick, DO, MPH, FAOCD; Andrew Blauvelt, MD, MBA; and Lisa Swanson, MD.

The panel of experts delve into the recent boom in solutions for patients with atopic dermatitis to have an enhanced quality of life. This Around the Practice series consists of nearly 15 episodes to discuss systemic vs topical treatment, switching up treatment, and patient experiences the panel shared. Here are a few episodes you don’t want to miss:

Use of Sysemic vs Topical Treatment of Atopic Dermatitis

Jonathan Silverberg, MD, PhD, MPH and aprofessor at George Washington University in Washington, DC, sparked conversation among his colleagues about deciding between the systemic options available. Everyone shared their approach to discussing biologics options with patients to best suit their treatment goals and lifestyles. 

Andrew Blauvelt, MD, MBA, aninvestigator at the Oregon Medical Research Center in Portland, Oregon, has run a small private dermatology practice for years. Since he has conducted mostly clinical trials, he opened up the conversation tobiologics vs JAK inhibitors, which he has extensively researched. “There were 2-plus years where we have had open trials for tralokinumab and/or lebrikizumab, and abrocitinib and upadacitinib at the same time. I’d do what we do in practice—I’ve done it for 3 or 4 years—going through the pros and cons of each class and then [listening to] what they say,” he explained. “It’s been fascinating...having these conversations, but in the context of clinical trial choice, it’s been about half and half.”

Switching Treatment in Atopic Dermatitis

Changing treatment direction to best suit a patient can be a tough decision that comes down to asking the right questions. The panel agreed with a collaborative approach.

“I tend to stick with the basic approach of asking patients if they’re happy. Is the patient happy, or do they wish they could be doing better? If it’s difficult for them to say that, I say, let’s think back to before starting dupilumab. Where would they rate the severity of their symptoms on a scale of 1 to 10? Then where would they put themselves today? Is that enough improvement, or are they still at a 5 or a 6? By putting it contextually in those numbers, the patient realizes that maybe they could do better,” shared Lisa Swanson, MD, who practices at Ada West Dermatology in Boise, Idaho.

Patient Case #1: Atopic Dermatitis Treatment Options

Blauvelt, Glick, Swanson, and Silverberg were presented with a pediatric AD case with a 6-year-old boy with the previous treatment consisting of nonpharmacological products and multiple topical corticosteroids. The panel discussed their approaches to treating the patient with worsening rashes.

“This child is missing preschool, and that’s really impactful. I agree with the treatment regimen. Nowadays, I’m having clear conversations about biologic therapies with some of my parents too. I’ve used dupilumab, which is our only agent available in this space,” said Brad Glick, DO, MPH, FAOCD, and board-certified dermatologist and dermatologic surgeon at Glick Skin Institute in Margate and Wellington, Florida. “Maybe we’ll get other biologics and oral systemic therapies. There might be some other possibilities. Maybe low-dose methotrexate. We could get a little more complicated if it’s more moderate and not a severe case per se.”

Click here to watch the full series.

Reference

1. Silverberg J, Swanson E, Blauvelt A, Glick B. Atopic dermatitis first line treatment options: Systemic therapies for moderate-to-severe AD. Dermatology Times. May 9, 2023. Accessed May 18, 2023. https://www.dermatologytimes.com/around-the-practice/atopic-dermatitis-first-line-treatment-options-systemic-therapies-for-moderate-to-severe-ad