Discussing Unmet Needs Among Patients in Dermatology, with Matthew Zirwas, MD

In an Maui Derm NP+PA Fall 2024 conference interview Nashville, the HCPLive team interviewed Matthew Zirwas, MD, the director of the clinical trials and dermatitis center at Dermatologists of Greater Columbus, about his review of recent literature and the biggest unmet needs among patients given the drug options he highlighted.

In his prior interview segment, Zirwas pointed to off-label treatment strategies for patients with different conditions such as psoriasis and acne. Here, Zirwas was asked what unmet needs were left to focus on among patients in dermatology.

“What I see is the biggest unmet need at this point is widespread atopic dermatitis, so high (body surface area) but low severity,” Zirwas explained. “So somebody who's just a little bit red, a little bit scaly, but gets it over too much of their body to be able to be treated in a reasonable way topically.”

He noted that all of the US Food and Drug Administration (FDA)-approved systemic agents for atopic dermatitis are for moderate to severe disease. Zirwas added that mild cases with wide body surface area among atopic dermatitis patients still need help.

“We still really need something there, and that is one of the places that I will now use the oral roflumilast cream if they're not severe enough for me to be able to get them on an FDA-approved therapy,” Zirwas said. “(Such as) a biologic or JAK inhibitor.”

Another area in which Zirwas believes there are unmet needs for patients is in the area of hand eczema. For the most part, Zirwas noted, hand eczema is referred to as atopic hand eczema as then patients can access JAK inhibitors or a biologics.

“But that's still difficult, because the systemics are hard to get as it's such low body surface area,” Zirwas explained. “The topical JAK inhibitor that we have works well, but for a lot of these people, it's a stretch to call it atopic dermatitis, because hand eczema is very often an overlap between atopic hand eczema, irritant contact dermatitis, and allergic contact dermatitis.”

Zirwas added that in his experience thus far, topical JAK inhibitors are substantially more effective than even ultra-high potency topical steroids, though he added that there is still no available drug that is approved for chronic hand eczema.

“We're expecting that later this year we're going to get a drug from Leo called delgocitinib that's completed their phase 3 trials, and we're hopefully going to have that drug within the next year,” Zirwas said. “I think it is going to be a phenomenally effective and useful drug for chronic hand eczema.”

To find out more about this conference topic, view the full interview segment above.

The quotes used in this description were edited for the purposes of clarity.

Zirwas reported being a consultant and investigator for Arcutis Biotherapeutics, and has received grants from Amgen and UCB and personal fees from AbbVie, Dermavant, EPI Health, Galderma, Genentech/Novartis, Incyte, L’Oréal, Lilly, Pfizer, Regeneron, and Sanofi.