Dr Matthew J. Zirwas: How Launch of New Biologics May Change AD Management

Matthew J. Zirwas, MD, a dermatologist in Ohio, discusses how dermatologists may stratify patients with atopic dermatitis (AD) with the launch of new biologic treatments in 2021.

Transcript

If new biologic treatments for atopic dermatitis launch in 2021, how do you anticipate dermatologists will manage the different products for different populations?

So one of the things that's emerged as most important with dupilumab is they have very strong data showing a pretty dramatic reduction in infections in patients with atopic dermatitis. And we didn't realize we didn't have good data around this until recently. And the best data really suggests that the rate of what you would call a serious infection in people with moderate to severe atopic dermatitis is about 2% a year. So, for every 50 people with moderate to severe atopic dermatitis, one of them will get a severe infection every year. And again, the best data that we have says that dupilumab cuts that risk and a half. And so it becomes something that goes from being a quality of life issue, where atopic dermatitis is devastating for quality of life; it has a much bigger impact on quality of life than does psoriasis. You know, the other big disease in dermatology. And we've thought of treating atopic dermatitis as a quality of life issue, but it turns out that it's really a safety issue. So the rate of serious infections is way above what anybody realized, and that dupilumab really cuts that risk dramatically is enormously important. That's going to play a big role in how we utilize other therapies that come on the market. Are they going to have similar data that says not only do we get the disease better, but do we also protect people from serious infections, and that's going to be a big part of it.

The other thing that's going to be a big part of it are what I phrase as “annoying side effects.” So dupilumab—one of the things that has made it an incredible drug has been that it doesn't have any dangerous side effects. It has some annoying side effects, or conjunctivitis, which can be a pretty significant and annoying for patients. It can cause other rashes to break out. So it gets their eczema better, but they break out in other rashes. And then in rare cases, it can cause arthritis. None of those are dangerous in any way. But they're very annoying, and they're relatively common. It's going to be another really interesting question, how do these other drugs compare to dupilumab, in terms of the frequency of those kinds of annoying side effects? And then, how's the efficacy? And I don't think with the biologics that are likely to come out this year, I don't think we have head-to-head data. And so it's going to be some trial and error. I think initially, what's going to happen is that dermatologist will take their patients who have either had a side effect on dupilumab, or have had an inadequate response to dupilumab and they will try switching them over to the new biologics that come out. And that's I think, where the initial experience will happen with dermatologists—we'll get to see how these drugs compared to dupilumab. And then I think as we get a better sense from those patients, then it'll start to become more of a question of which of these drugs makes the most sense as first line for a given patient. But I think initially, it's until we have more of the data around comparative efficacy, the rates of those annoying side effects and the reduction of infection risk, I think initially, the very first place that we use for people who have had side effects with dupilumab or have had an inadequate response to dupilumab.