Research pays dividends in atopic dermatitis therapies

For the past dozen years, atopic dermatitis has been studied in more than 120 clinical trials and has been the subject of more than 3,000 papers. This work is paying off with an increased understanding of the disease pathophysiology and the development of topical and systemic treatments.

“The thing I want to highlight the most is that we have an innovative and growing pipeline. Atopic dermatitis is an extraordinarily common condition, yet it was treated almost like an orphan disease with both minimal research and new developments until recently. Now, it has really taken center stage, very similar to what we saw with psoriasis 10 to 15 years ago,” said Adam Friedman, MD, associate professor of dermatology at the George Washington School of Medicine and Health Sciences, D.C.

Dr. Friedman will present “New and Emerging Therapies for Atopic Dermatitis” in Friday’s “New Emerging Therapies” (S011) session, from 1 to 4 p.m. in Ballroom A.

The “new” aspect of the presentation will look at the study of the microbiome and how it relates to skin disease, the increased knowledge of the 500 species of organisms that exist on the skin, and that more than 1 million organisms share each square centimeter of skin.

“Because of the alerted skin topography in atopic dermatitis resulting from the inherent barrier defects, there are documented shifts in the microbial population favoring certain bacteria that can cause significant harm and perpetuate disease, such as Staphylococcus aureus,” said Dr. Friedman.

One school of thought to ameliorate this imbalance is to provide the resources to restore an equilibrium among bacteria, called prebiotics.“The term prebiotic has not hit the mainstream yet, but it is a very hot area that will translate into therapeutics down the road,” Dr. Friedman said. “The focus has predominantly been on probiotics, which no question has great potential. There is an ongoing NIH-funded clinical trial looking at autologous microbial transplants in stabilizing atopic dermatitis.”

Another important area of research is itch, or pruritus, which in atopic dermatitis can both be a direct result of inflammation, but more often an independent symptom resulting from a broad range of biological factors.

“Understanding itch and developing new therapies is a major thrust in emerging therapies,” Dr. Friedman said.

Other topics Dr. Friedman plans to discuss include:

  • Dupilumab is the first biologic agent designed for atopic dermatitis, and it is in phase III trials. It is an IL-4 and IL-13 receptor blocker and has been studied in once-weekly and bi-monthly doses.
  • Stabilized hypochlorous acid preparations, similar to bleach, which have potent anti-itch properties.
  • Crisaborole with 2 percent ointment, a boron-based PDE4 inhibitor is a new, active agent that is in phase III trials and could be on the market in the next few years.
  • Apremilast is a PDE4 inhibitor approved for psoriasis and psoriatic arthritis. There is evidence to support its use off-label for atopic dermatitis.

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