Transcript
Tina Bhutani-Jaques:
In the past, we tended to choose our therapies based on how much disease a patient had, whether they had more limited body surface area, which guided us to treat with topicals alone, or whether they had more extensive disease where we tended to lean toward systemic agents. However, we now have a new expanding toolbox of treatments for our patients with atopic dermatitis, and a lot of our topicals actually are very effective and can be used long-term. And so there's a possibility that our patients with more moderate to severe disease can actually benefit from the use of those medications.
In particular, I like to point out that the clinical trials for tapinarof cream, which we now have available for the treatment of atopic dermatitis, actually involved patients with moderate to severe psoriasis. In particular, I like to point out that the clinical trials for tapinarof cream, which is one of the newer non-steroidal topicals that we have for atopic dermatitis, actually focused on patients with more moderate to severe disease. So unlike previous clinical trials for topical agents that focused on mild to moderate disease, this drug actually looked at a population of patients that was moderate to severe. And in that trial, we saw great efficacy and really good safety. The drug was well-tolerated, and this tells us that for a certain number of patients, we might be able to treat with topical therapy even if they have more extensive disease.
When we think about topical therapy, there's a lot of factors that we want to evaluate when we're talking to our patients. One is we need to make sure that the drug is effective, it's safe, and that it's tolerable when patients are using it, because an issue that we've had with, especially non-steroidal topicals in the past, has been things like burning, stinging, application site pain. The nice thing is with a lot of our newer non-steroidal topicals, we don't see those tolerability issues, which makes it easier for patients to use and be compliant with these therapies.
The other things that we look for are the vehicle itself, the vehicle that the topical medication is created in, because sometimes the vehicle can cause more problems than the medication itself. So we want to make sure that not only is the vehicle elegant, but again, that it doesn't have a lot of chemical sensitizers, things that patients can become allergic to, that again, that it has a balanced pH, so it doesn't burn or sting. And most importantly, something that the patients are going to feel nice putting on their skin. So those are things that we take into account. Then, when it comes to certain areas of the body, areas like the scalp, the intertriginous areas, hands, which can oftentimes be affected in atopic dermatitis, again, we want to have something that's light, that blends in, that's not going to be greasy and overbearing for patients as they use it.
So even though we have data to show that topical therapy alone can oftentimes treat patients with moderate to severe disease, we want to make sure that we're not undertreating these patients. And so many times, we will start the discussion about systemic therapy, trying to get the disease under better control quickly for these patients. But that doesn't mean that we forget about topical therapy. As the drug takes effect, as we start a biologic or as we start an oral drug, it's going to take some time for the medication to start working. And during that time, it's critical that patients are compliant with their topicals. I oftentimes tell them if they can decrease that inflammation with the topicals, that systemic drug will work much faster. So we want to be sure to counsel patients on that.
The other thing we know is that atopic dermatitis is a chronic relapsing remitting disease. So even though we're hoping to decrease the number of flare-ups in a year, we're hoping to decrease the severity of those flare-ups, patients are still going to get some flare-ups. And with that, topical therapy as an adjunct to systemics can be very helpful.
What I love about some of our newer non-steroidal therapies is that there's no limit to time of use. So when we prescribe something to the patient, they're not going to get a warning from their pharmacist that says they have to stop using it after two weeks, because we know that with atopic derm, it can oftentimes take longer than that to clear the skin. And if they stop things too soon, the disease comes right back. So we want things that our patients are going to be able to continue in the long term. This is important not only for flare management, but also for maintenance. So I often tell my patients that you use it every day while your skin is active, and then when your skin is well controlled, you can step down to using it two or three times a week. Sometimes patients can even stop treatments in between, but if they do choose to continue treatment, they don't have to worry about any long-term sequelae or long-term consequences of long-term use with these non-steroidal topicals.
Topical steroids are great for acute management of atopic dermatitis, but in the long term, we know that we can't use them due to risk of long-term side effects. That's where non-steroidal topicals become key for our patients. I tell my patients, "Keep it in a drawer. Anytime you notice your disease recurring, immediately start to use it. The faster you start treatment, the faster it will go away." And also, don't under-treat your skin. So you want to continue to use it as long as you need to get your skin clear. If you stop it too soon, your disease will likely recur quicker. The nice thing with the non-steroidal topicals is we don't have a time limit, so they can use it as long as they need to, to get their skin clear and to ensure that their disease doesn't recur quickly.
As we get more treatments for atopic dermatitis, it's a really exciting time for our patients because now we can actually provide them with options. We can tell them we have multiple topicals, we have oral agents, we have biologics. We even have phototherapy still. And when it comes to topical therapy, we can even get in and nail down even deeper. We can talk about vehicles. We can talk about frequency of use. We can talk about how much body surface area they can use it on. So we can really customize treatments for our patients, which is very exciting. And I think it opens up the conversation, helps to build a rapport with your patient, and ensures that they're going to be compliant in the long term.
