Research shows promising treatments for patients with AD

Emma Guttman-Yassky, MD, PhD: “This is proof the disease is reversible, an immune-driven disease, like psoriasis. This is a game-changer and a life-changer.”

After a prolonged period with few advances in the treatment of patients with atopic dermatitis (AD), researchers are excited about the possibility of advances based on studies of several biologics, led by dupilumab.

Emma Guttman-Yassky, MD, PhD, highlighted those advances Saturday during the “Hot Topics” presentation of “New Developments for Atopic Dermatitis.” She is a professor in the department of dermatology and vice chair of the immunology institute at Icahn School of Medicine at Mount Sinai.

Much of the work on the study of atopic dermatitis has yielded information revealing it as a systemic disease with immune responses similar to those in patients with psoriasis, she said. There is increased T cell and circulatory cytokine activation, and its two most important T cells are Th2 and Th22.

“Can the psoriasis model be applied to atopic dermatitis? The answer is ‘yes,’” Dr. Guttman-Yassky said.

To test the contribution of different immune axes to AD, several clinical trials are focused on treatments of patients with atopic dermatitis, which she reviewed.

A four-week study led by Dr. Guttman-Yassky gave patients weekly injections of dupilumab, with good results, and newer research showed that it reverses inflammation and atopic dermatitis barrier defects. Dupilumab, an IL-4 and IL-13 inhibitor, has not been approved by the Food and Drug Administration.

“This is proof the disease is reversible, an immune-driven disease, like psoriasis,” Dr. Guttman-Yassky said, adding that dupilumab’s safety profile is good. “This is a game-changer and a life-changer.”

The TREBLE trial studied the effectiveness of the IL-13 inhibitor lebrikizumab in patients with moderate to severe atopic dermatitis, and the results were promising. However, researchers realized that using topical steroids should be avoided in clinical trials as they might confuse results of AD clinical trials due to large placebo effects, she said.

Another study looked at the use of an anti-IL-31 receptor monoclonal antibody, nemolizumab, which showed that it helped patients with moderate to severe atopic dermatitis.

Another study led by Dr. Guttman-Yassky targeted IL-22, which is involved in the epidermal hyperplasia and barrier defects in atopic dermatitis and might prove to be effective in chronic AD patients.

“This is a positive study,” she said. “I do think we have something there.”

Yet another study targeted the IL-23/Th17 axis in AD with ustekinumab. It did not hit its endpoints, but did show promise, leading Dr. Guttman-Yassky to again add, “I think we have something there.”

Other trials looked at apremilast and both oral and topical tofacitinib, which all showed promise, as did topical JAK inhibitors.

“The therapeutic landscape for AD is changing rapidly with testing and development of many therapeutics to provide safer and better long-term disease control,” Dr. Guttman-Yassky said.

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