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  • Presentation

Systemic Therapy for Adults: What's Here/What's Coming?

Description

The presentation discusses systemic therapy options for adults with atopic dermatitis, highlighting the challenges of therapeutic inertia in treatment. A case study of a 27-year-old patient emphasizes the importance of proper diagnosis and treatment options beyond steroids. The speaker outlines various drug classes, such as biologics and Janus kinase (JAK) inhibitors, illustrating their pros and cons, including efficacy and side effects. The discussion includes potential new therapies on the horizon and the importance of shared decision-making with patients. Key points include the significance of understanding the disease as chronic, overcoming treatment inertia, and adapting treatment based on patient responses and adverse events. The presentation stresses the need for rigorous patient communication and explores alternatives when patients experience insufficient improvement or adverse reactions. Additionally, the speaker introduces new options like Nemo, which shows promise in terms of rapid itch relief without conjunctivitis. The talk concludes with a positive outlook on emerging therapies and emphasizes the necessity of ongoing evaluation of treatment strategies.

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Conclusions

  • Therapeutic inertia is a significant barrier in treating severe atopic dermatitis; providers should actively treat rather than relying solely on systemic steroids.
  • It's essential to recognize and treat atopic dermatitis as a chronic condition rather than continually searching for causes.
  • New drug options, particularly biologics like nemolizumab, present exciting opportunities for patient care without the side effects associated with older treatments.
  • Biologics demonstrate efficacy in improving signs, symptoms, and quality of life indicators for patients suffering from atopic dermatitis.
  • Appropriate decision-making with patients regarding drug classes can enhance treatment success and patient satisfaction.
  • Biologics, especially Dupilumab, Tralokinumab, and Lebrikizumab, offer varied advantages and disadvantages, and the choice of treatment should consider each patient's specific situation.
  • Patients may experience facial dermatitis or other skin reactions while on biologics, which can often be confused with treatment efficacy and may necessitate alternative approaches.
  • Management strategies should include evaluating patients for potential side effects and being proactive in switching therapies when necessary for better outcomes.
  • Abeck F, Booken N, Schneider S. Unsachgemäße Systemtherapie bei schwerer atopischer Dermatitis - fatale Langzeitschäden. Hautarzt. 2021 Dec 14. German. doi: 10.1007/s00105-021-04922-1. Epub ahead of print. PMID: 34905073.
  • Halioua B, et al. Therapeutic inertia in the management of patients with inadequately controlled atopic dermatitis. J Eur Acad Dermatol Venereol. 2022.
  • Katsuta, M ., Kamide, R ., Ishiuji, Y ., Nobeyama, Y ., & Asahina, A. (2024). Bullous Pemphigoid that Developed During Nemolizumab Treatment for Atopic Dermatitis: Two Case Reports. Acta Dermato-Venereologica, 104, adv40634.
  • Beyrouti A, et al. Switching From Dupilumab to Tralokinumab or Janus Kinase Inhibitors in Cases of Ocular and/or Facial Adverse Events in Patients With Atopic Dermatitis: A Multicenter Retrospective Study. J Allergy Clin Immunol Pract. 2024 Dec 12:S2213-2198(24)01241-8. doi: 10.1016/j.jaip.2024.12.001. Epub ahead of print. PMID: 39672377.
  • Bieber T, Simpson EL, Silverberg JI, Thaçi D, et al. Abrocitinib versus Placebo or Dupilumab for Atopic Dermatitis. N Engl J Med. 2021 Mar 25;384(12):1101-1112.
  • Blauvelt A, Teixeira HD, Simpson EL, et al. JAMA Dermatol. 2021;157(9):1047-1055.
  • Silverberg JI, et al. Comparative Efficacy of Targeted Systemic Therapies for Moderate-to-Severe Atopic Dermatitis without Topical Corticosteroids: An Updated Network Meta-analysis. Dermatol Ther (Heidelb). 2023 Oct;13(10):2247-2264. PMID: 37658223; PMCID: PMC10539231.