Atopic Dermatitis and Psoriasis: Current Treatment Landscape and Future Outlook
Key Points:
- Revolution in Therapies: The field of atopic dermatitis (AD) is experiencing a significant transformation, with numerous new therapies either recently introduced or soon to enter clinical practice.
- Heterogeneity of Disease: AD is a highly heterogeneous condition, meaning that different patients respond differently to various treatments. While some new therapies show promise, they do not work for everyone.
- JAK Kinase Inhibitors vs. Biologics: Some JAK kinase inhibitors, such as upadacitinib and abrocitinib, have shown more impressive results compared to biologics like dupilumab. However, JAK inhibitors come with potential safety concerns.
- Health Economics Impact: In health economics-driven regions like the UK, the availability of these new therapies is often restricted based on disease severity, leading to a significant portion of patients still relying on older treatments like topical corticosteroids.
- FDA Approvals and Label Changes: In the US, the FDA has been more cautious with JAK inhibitors, leading to changes in labeling, such as the updated label for Xeljanz. In contrast, European regulatory bodies have been more relaxed.
- Specific Drug Evaluations:
- Upadacitinib: Has the best data among JAK inhibitors and is superior to dupilumab at early time points.
- Abrocitinib: Also shows promising results, but the higher dose has been trialed against dupilumab, showing superiority at early time points.
- Tralokinumab: Data is less robust compared to dupilumab, with limited efficacy and poor response rates.
- Lebrikizumab: Shows promising Phase II data, potentially on par with dupilumab in terms of EASI 50, EASI 75, and EASI 90 responses.
- Psoriasis vs. Psoriatic Arthritis: The choice of treatment varies depending on whether the patient has associated psoriatic arthritis. IL-17 inhibitors (like bimekizumab) are preferred for psoriatic arthritis, while IL-23 inhibitors (like guselkumab) are considered the gold standard for psoriasis due to their safety profile and favorable dosing schedule.
Access and Availability:
- Current Usage: Baricitinib is currently being used in the UK, with abrocitinib expected to be approved shortly. However, these drugs are not widely accessible due to NICE assessments and high costs.
- Dose Considerations: In the US, the lower dose of baricitinib is approved, while in Europe, the higher dose might be preferred for certain patient groups, especially the elderly and vulnerable.
Overall, the landscape for treating atopic dermatitis and psoriasis is rapidly evolving, with multiple new therapies offering hope for patients. However, access and efficacy challenges remain significant, particularly in health economics-driven regions.
