Dr Jonathan Silverberg on Ruxolitinib and Other Exciting Developments to Come at AAD VMX

We really want to understand as much as possible and fill in as many gaps as possible to get a better understanding of treatments for atopic dermatitis, noted Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology, George Washington University School of Medicine and Health Sciences, in an interview ahead of this year’s American Academy of Dermatology Virtual Meeting Experience (AAD VMX). He is an author of the poster, “Efficacy of Ruxolitinib Cream Among Patients With Atopic Dermatitis Based on Previous Medication History: Pooled Results From Two Phase 3 Studies.”

Transcript

Can you give us a preview of your poster being presented at AAD VMX this year?

This is an interesting study. The issue of cycling through topical treatments or if a patient fails conventional topical steroids, where do they go next is a very important question that happens in clinical practice.

This is a post hoc analysis. Data were presented already for ruxolitinib showing that for the primary analysis and all-comers, the drug works very well—is arguably one of the best, most potent topicals we've seen so far in the field. But there's still this question of, is there a difference between those who perhaps were exposed to some treatments previously or not? And perhaps the treatment-naive patients might do better and maybe not. This study really sought to understand treatment response stratified by those who've had different treatment exposures previously.

What was found was that at week 8, which was the primary efficacy end point in this particular study, was that the primary end point, the IGA [Investigator’s Global Assessment Scale] treatment success, was achieved, was significantly better for both doses of ruxolitinib compared to placebo, overall. That was one of the previous findings.

But more importantly was that the treatment success rates were higher in patients who used ruxolitinib. Again, regardless of the dose rate, regardless of their previous medication history, whether they used topical corticosteroids beforehand. We still saw robust response if they used topical calcineurin inhibitors before; they still had a robust response. And interestingly, even if they used systemic therapies—you might think that's a whole different ballgame. So patients who are on systemics may not do as well—in fact, they also do quite well on topical ruxolitinib.

And so, similar findings were found for not just the IGA treatment success, but also for other key end points, like the EASI-75, which is a 75% improvement of the Eczema Area and Severity Index, or meaningful reductions of itch, which in this case would be a 4-point reduction in itch on the Numeric Rating Scale.

Overall, the results suggest that ruxoliltinib is a good potential destination, potential treatment, regardless of where patients are coming from in terms of their treatment history.

What will be some of the biggest developments to come out of this year's meeting?

It's been very challenging for clinicians to be able to keep up with everything that's been going on, because their routine has been disrupted substantially. I think we've seen just a ton, an absolute enormous amount of data being presented in terms of post hoc analyses. And we're going to see also a variety of late-breaking presentations as well, with some really cool cutting-edge data, which really just refines our understanding.

In the case of the post hoc analyses, it's for drugs that we already have data for, like ruxolitinib in the topical realm; baricitinib, abrocitinib, upadacitinib in the oral realm; tralokinumab in the injectable realm. And we know a lot about these drugs already, but we're really filling in those gaps and learning more and more about the different nuances and [which patients tend to be] the super responders.

So I think it's just really exciting, as we get a better understanding of these drugs. And especially to try to fill in as many of those gaps as possible, given that we expect approval for these in the next few months—we really want to understand as much as possible before they are approved.