Dr Jason Ezra Hawkes Discusses Clinical Considerations for Biologic Treatment in Atopic Dermatitis

Managing moderate to severe atopic dermatitis (AD) with biologic therapy requires shared decision-making between the dermatologist and patient to ensure that the pros and cons of each therapy are known and the right drug is given, said Jason Ezra Hawkes, MD, MS, FAAD, board-certified dermatologist and associate professor of Dermatology at the University of California Davis in Sacramento

Transcript

Can you discuss factors to consider in recommending biologic treatment for a patient with AD, whether as monotherapy or in combination with other medications?

When I think about biologics, I'm thinking about the severity of the patient. We were trying simpler things for maybe more localized disease or mild disease, but we need to sort of up our game in terms of treatment and management strategies as disease worsens. And so dupilumab was really a game changer for the treatment of AD, because it was so effective in so many patients, and the tolerability was actually very, very good.

So, I really rarely see lack of effectiveness or issues with tolerability with dupilumab, for example. So, it's been a big success for a lot of patients and we've seen other biologics that are coming out, specifically those that just block IL-13, for example, rather than IL-4 and IL-13. That also shows promise, but, as mentioned, these therapies don't always work for every patient. Some patients aren't responders, or it’s not covered by insurance, or they're afraid of injections. So, we also have to think about other strategies. Sometimes we have to use some of the oral medications or phototherapy; methotrexate or cyclosporine, for example, are sometimes required.

So, when we start thinking about these therapies, we want to have that shared decision-making conversation with patients and talk about the pros and cons. And most of the time, I'd say with biologics, we will sort of stick with monotherapy because it works for most patients. But occasionally, we need to add on other therapies like topical steroids, as I mentioned, methotrexate, which can be used safely with dupilumab, for example.

We're starting to see new therapies populate this space. Janus kinase (JAK) inhibitors are a class that'll be very exciting for this area, but it will also have its pros and cons. So, again, I think it comes back to having that shared decision-making conversation with our patients, so that they really understand what the ups and downs of the therapies are, but more importantly, we want to make sure that we ultimately find that therapy that alleviates the burden of this disease on our patients.