Addressing Unmet Needs, Emerging Treatment for Atopic Dermatitis: Raj Chovatiya, MD, PhD

Raj Chovatiya, MD, PhD, MSCI, clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology/Immunology Research, emphasizes promising atopic dermatitis research aiming to identify patient subgroups for targeted treatments using biomarkers and clinical traits.

He points to key unmet needs in managing moderate to severe cases, including long-term control, predictable treatment with potential for dosing flexibility, comprehensive skin and itch improvement, and safety. Chovatiya suggests that precise, biomarker-driven treatment selection isn't yet fully realized, with current decisions relying on clinical context, patient preferences, and shared decision-making alongside molecular insights, anticipating more reliable predictive tools in the future.

This transcript was lightly edited for clarity; captions were auto-generated.

Transcript

What emerging research areas in atopic dermatitis are you most excited about, and how do you see these advancements potentially impacting the future of patient care and treatment strategies?

There's been a few areas that there's been a lot of investment placed in for atopic dermatitis, and it's not sure exactly what the outcome is going to be, but one of the really exciting areas has been this idea of really trying to come up with therapeutically relevant patient subsets. Can we use biomarkers or clinical features to really divide up patients into groups that might be of benefit of one specific therapy over another?

Now all we've learned so far is that, generally speaking, cytokines like IL-13, IL-4, and others are generally important for most patients, but there still is a little bit of fine tuning and flavor from patient to patient, and that's where the second arm of investigation has largely been centered around. This is really taking a look at people who maybe are going to be getting targeted at a different immune nexus or different part of the immune cascade.

A lot of our therapies have really been centered around individual cytokines or groups of cytokines, but if we are able to be targeted but more broad in our therapeutic approach, could this potentially help a lot more people?

Finally, this concept of remission is one of the hottest things in atopic dermatitis. Every therapeutic approach is really trying to understand how can we best probe and ask this question, and are there patients truly that if they get an adequate response, they actually can achieve long-lasting response off therapy? All of those are really, really exciting to me, since we just don't know the answer.

What are the most pressing unmet needs in the management of moderate to severe atopic dermatitis?

We know that patients really want to have long-term control of their disease. Atopic dermatitis is not a short-term therapy, but a long-term therapy. We know people want to have a highly predictable experience in the long run, potentially even spacing out their dosing, or maybe even the possibility of taking breaks off of their therapy as well.

People want to not only have lesion improvement, but itch improvement, and people want both the ability to see things are happening when they started therapy, but also things are continuing to improve while they continue with therapy as well.

Of course, safety above all, frankly, maybe one of the most important things for our patients with atopic dermatitis. Now, each of those little elements I named, they're all areas that have really been shown to be very promising aspects of lebrikizumab as far as treatment of moderate to severe disease. When having that kind of discussion with my patient, this is where a therapy like that really falls in to highlight some of the ways that we can address those concerns our patients may have.

With the growing availability of biologics, how do you see the field of dermatology evolving in terms of personalized medicine and precision therapeutics for atopic dermatitis?

Well, when it comes to precision medicine, we're kind of, sort of, but not really exactly there yet for atopic dermatitis, so let me explain. We understand many of the targets that are important in this disease, but atopic dermatitis is not singularly a “one target with 100% outcome” type disease as well.

Additionally, it isn't clear so far that, based on that therapies we have, there are very specific therapeutic subsets where you have to use one therapy over another. This goes back to that point that I brought up again. Oftentimes, our choices are dictated by the clinical scenario, what I'm looking for, what my patients are looking for, and again, this concept of shared decision-making. Now, that might change in the future, as we understand some more of the science behind the disease, and we have even more therapies, but I think that it's still really, really important to note that oftentimes matching the right patient to the right treatment is much more so than just knowing something about this molecular background, meaning that they are on this therapy.

Hopefully that will change in the future, and we can actually very reliably predict who might be the right person for the right choice. As of now, I think that it's really important just to emphasize some of the clinical phenotypes and patient desires alongside with what you know and rely on for patient treatment.