New AD Research Indicates 'New Standards of Care'
The bar has been raised for atopic dermatitis (AD). That was the message in “Is EASI 75 Good Enough or Can We Do Better? Elevating Efficacy and Long-Term Safety With JAK Inhibitors in Moderate-to-Severe Atopic Dermatitis,” a presentation from Drs. Christopher Bunick, Brad Glick, and Alexandra Golant at the 44th Annual Fall Clinical Dermatology Conference.
The doctors emphasized that the approach now should be to get patients “as clear as possible,” not just to Eczema Area and Severity Index (EASI) 75. Dr. Golant noted that many AD patients do not know they can become completely clear.
“We can achieve these high bars with the therapeutics that we have in the toolbox right now,” Dr. Glick said.
Dr. Bunick noted a study that he co-presented in a poster at the conference, “Utilization and Duration of Systemic Corticosteroid Exposure in Atopic Dermatitis Patients After the Introduction of Advanced Therapies: A Population-Based Study From the United States,” which found that approximately one in five patients with AD is prescribed a systemic corticosteroid, and that nearly one-quarter of those patients have long-term exposure (>90 days).1
“If there is one thing I can ask you to do today,” Dr. Bunick said during the presentation, “please stop writing systemic corticosteroids for atopic dermatitis patients.”
The doctors then summarized the latest data on various biologics, including the LEVEL UP trials involving upadacitinib.2
“We talked about the new standards of care in atopic dermatitis from the AHEAD recommendations, treat to optimal target, achieving minimal disease activity, and then showing how it was implemented in the LEVEL UP clinical trial, which was a head-to-head comparison of upadacitinib per label with dupilumab per label, with a special 16-week chance to switch from those that were on dupilumab and did not achieve EASI 75 to upadacitinib 15 mg, and see how they did over the ensuing 16 weeks there,” Dr. Bunick told Practical Dermatology. “Ultimately, the AHEAD recommendations included that patients’ quality of life is best improved when you have two different metrics that are achieved: a clinician-reported outcome, such as EASI 90 or IGA 0/1, plus a patient-reported outcome, like achieving itch 0/1 on a 10-point scale. We presented data showing what this concept is of minimal disease activity, explaining Period 1 of the LEVEL UP clinical trial and presenting new data for Period 2. What was really fascinating is that approximately 70% of the patients who were switched from the dupilumab to the upadacitinib 15-mg dose achieved EASI 75 by Week 32. So, basically, upadacitinib was able to achieve what dupilumab could not. This really shows that if a patient is not responding to biologic therapy or any advanced systemic therapy for atopic dermatitis by 16 weeks, they really should be switched to a different medicine.”
- Bunick CG, et al. Switching from Dupilumab to Upadacitinib in Adults and Adolescents with Moderate-to-Severe Atopic Dermatitis and Inadequate Response to Dupilumab: Efficacy and Safety Results from the Phase 3b/4 LEVEL UP Study. Poster presented at: The 44th Annual Fall Clinical Dermatology Conference; October 26, 2024; Las Vegas, NV.
- Bunick CG, Vleugels RA, Lebwohl M, Grada A, Yue EX, Wegrzyn L, D’Andrea E. Utilization and Duration of Systemic Corticosteroid Exposure in Atopic Dermatitis Patients After the Introduction of Advanced Therapies: A Population-Based Study From the United States. Poster presented at: The 44th Annual Fall Clinical Dermatology Conference; October 26, 2024; Las Vegas, NV.
Disclosures: Dr. Bunick has served as an investigator, consultant, and/or speaker for AbbVie, Allergan, Almirall, Amgen, Apogee, Arcutis, BMS, LEO, Lilly, Novan, Novartis, Ortho-Dermatologics, Palvella, Pfizer, Sanofi-Regeneron, Timber, and UCB.