Alexandra K. Golant, MD

Expert dermatologists share clinical pearls for providers treating patients with AD, and discuss the future of AD treatment.

Clinical Pearls for the Treatment of AD

This is a video synopsis/summary of a panel discussion involving Christopher Bunick, MD, PhD; Peter Lio, MD; Lisa Swanson, MD, PhD; and Alexandra Golant, MD.

Dr Swanson shares a clinical pearl emphasizing the importance of discussing with patients not only the potential side effects of medications but also the side effects of inadequately controlling atopic dermatitis (AD). She stresses the impact of uncontrolled AD on a patient's quality of life and well-being, highlighting how patients may not fully realize the extent of their suffering until effective treatment is administered. Dr Swanson suggests considering the metaphor of a slowly-heating bathtub to illustrate how AD can gradually worsen, affecting patients without them being fully aware.

Dr Golant adds to the discussion by focusing on severity score measures and the shift towards emphasizing quality of life. She suggests initiating systemic medications, including JAK inhibitors, based on the impact of AD on a patient's quality of life rather than solely relying on severity scores. The conversation also touches on the significance of recording accurate itch scores, connecting them to a tremendous difference in quality of life.

The clinical pearl from another colleague involves emphasizing patient compliance with JAK inhibitors. A patient's experience of rapid itch relief, akin to a light switch, underscores the importance of consistent medication adherence. Dr Swanson expresses enthusiasm about the future of AD management, anticipating advancements such as IL-31 inhibitors, additional IL-13 inhibitors, and non-steroidal topical medicines, reflecting the exciting prospect of a golden age in the treatment of atopic dermatitis.

Video synopsis is AI-generated and reviewed by HCPLive editorial staff.

Videos

dermatology biologics coordinators as a resource for getting better access to JAK inhibitors.

Access to JAK Inhibitors in AD

Dr Swanson discusses the challenges and successes in providing access to Janus kinase (JAK) inhibitors for her patients. While acknowledging regional variations, she highlights the importance of a dedicated biologics coordinator in streamlining access, emphasizing their role in navigating different geographies and parts of the country. Dr Swanson expresses gratitude for having an excellent biologics coordinator in her practice, underscoring the pivotal role these professionals play.

She also shares valuable information about the Dermatology Biologics Coordinators Society, an annual meeting resource providing tips and tricks for coordinators, fostering collaboration and support among professionals in the field.

Regarding payer issues, prior authorizations, and co-pay assistance, Dr Swanson emphasizes the benefit of being part of a large academic institution with an infrastructure supporting patients in accessing biologics. The Biologic Treatment Center, functioning like an experienced biologics coordinator, helps manage the exhaustive burden on the office.

The experts stress the importance of seeking help and utilizing available resources, including reaching out to local representatives, patient hubs, and company specialists, all contributing to the support package for ensuring patient access to JAK inhibitors. The discussion underscores that different models exist for accessing these medications, but the key takeaway is that there are effective ways to provide patients with access to JAK inhibitors.

Lisa Swanson, MD, PhD, highlights dermatology biologics coordinators as a resource for getting better access to JAK inhibitors.

Dermatology experts discuss the use of JAK inhibitors in clinical practice, highlighting their own experiences and use of JAKs alongside corticosteroids.

Utilizing JAK Inhibitors in Clinical Practice

Dr Lio shares his overwhelmingly positive experience with Janus kinase (JAK) inhibitors in treating atopic dermatitis (AD) since their approval. Patients have responded reliably and quickly, often achieving a new level of improvement previously unseen. He emphasizes the importance of the heterogeneity of individual patient responses and notes that almost every patient he has treated with JAK inhibitors has responded well.

Regarding dosing, Dr Lio primarily uses the starting dose for most patients, with only a few requiring adjustment. He even mentions the strategy of lowering the dose after achieving good control to minimize exposure, highlighting the flexibility of JAK inhibitors.

The discussion then shifts to switching from biologics to JAK inhibitors, a common scenario in Dr Lio's clinic. He notes the reliable and impressive clinical improvement in patients transitioning from biologics to JAK inhibitors, especially for those experiencing a decline in response or never achieving the desired outcome with biologics.

Dr Lio introduces the atopic dermatitis control tool (ADCT), a validated patient-reported outcomes survey that aids in assessing patient control. The ADCT, a concise set of questions taking less than a minute to complete, has been instrumental in revealing patients' true experiences and motivating them to seek better control.

The conversation concludes with insights into the evolving standards of care in AD treatment, acknowledging the current era's remarkable achievements in efficacy, safety, and patient-reported outcomes. Dr Lio expresses excitement about the ongoing transformation in AD management and the prospect of achieving stringent endpoints, ultimately improving patients' quality of life. The discussion also touches on the evolving landscape of clinical trials in AD, aligning with the higher metrics and expectations set by advanced therapies like JAK inhibitors.

Expert dermatologists speak on shared-decision making between the patient and the provider when it comes to selecting the right therapy for AD.

Treatment Selection of JAK Inhibitors for the Management of AD

Dr Golant and Dr Swanson discuss the nuanced approach to leveraging Janus kinase (JAK) inhibitors in the treatment of atopic dermatitis (AD) and the considerations when selecting therapies for AD patients. Dr Golant emphasizes the importance of patient preference and engaging in shared decision-making, considering the oral, once-daily pill nature of JAK inhibitors versus the subcutaneous injections of biologics. She stresses the need to understand the individual patient's disease extent and its impact on their quality of life to tailor treatment plans accordingly.

Dr Swanson echoes the sentiment of shared decision-making, portraying himself as the navigator and the patient as the captain, collectively deciding on the most suitable treatment route. The discussion delves into the possibility of transitioning patients directly from systemic corticosteroid use to JAK inhibitors, bypassing other treatments like biologics. Both doctors share instances where patients experienced significant improvement on JAK inhibitors, challenging the notion of using them merely as a bridge to biologics.

Dr Lio adds insights into patient cases where JAK inhibitors were chosen over biologics based on comorbidities, such as vitiligo or rheumatoid arthritis, emphasizing the importance of addressing multiple conditions with a single treatment. The doctors agree on the evolving real-world use of JAK inhibitors, acknowledging the changing landscape as comfort and confidence in prescribing these medications grow. They stress that, with a thorough understanding of monitoring requirements, patient selection, and the role of JAK inhibitors, it is appropriate to use them in different ways and sequences tailored to individual patient needs.

Alexandra K. Golant, MD

Articles