Ellen Sher, MD: Cross-Specialty Collaboration Can Improve Atopic Dermatitis Management

The field of dermatology has found itself as the beneficiary of paradigm-shifting advances across a multitude of disease states in the last decade, with atopic dermatitis serving as a prime example of these new, pharmacotherapy-driven revolutions in care.

Beginning nearly a decade ago when approvals for dupilumab (Dupixent) and other agents ushered in the age of biologics and continuing to approvals for topical nonsteroidal options, such as ruxolitinib (Opzelura) and roflumilast (Zorvye) in 2021 and 2024, respectively.

The September 2021 approval of ruxolitinib cream marked the first US-approved topical JAK inhibitor, with the US Food and Drug Administration awarding it an indication for short-term and noncontinuous treatment of mild to moderate atopic dermatitis in nonimmunocompromised patients aged 12 and older whose condition is not adequately controlled with topical prescriptions or when such treatments are inadvisable. This approval was supported by data from the TRuE-AD program, including the phase 3 TRuE-AD1 and TRuE-AD2 trials.

In these randomized, double-blind, vehicle-controlled phase 3 trials, patients aged 12 and older with atopic dermatitis for at least 2 years, an IGA score of 2/3, and 3% to 20% affected body surface area were enrolled. Pooled data showed a significantly greater proportion of patients achieved the primary endpoint of IGA-TS at week 8: 44.7% in the 0.75% ruxolitinib group, 52.6% in the 1.5% group, and 11.5% in the vehicle group (P < .0001).

To learn more about the role of ruxolitinib cream as well as how the evolving treatment paradigm of atopic dermatitis has resulted in a need for multidisciplinary collaboration between dermatologists and allergists, HCPLive Dermatology caught up with subject matter expert Ellen Sher, MD, an allergist and immunologist with Allergy Partners of New Jersey, following an HCPLive clinical forum event at the American College of Allergy, Asthma and Immunology 2024 annual meeting.

During the conversation, which is featured below, Sher highlighted the integral role allergists play in the holistic management of atopic dermatitis, noting that patients often present with multiple Type 2 inflammatory diseases, such as asthma, allergic rhinitis, and food allergies. She noted allergists frequently manage these comorbidities alongside skin symptoms, which requires a care approach from an immunological perspective.

Sher underscored the importance of collaboration with dermatologists, who often address the skin symptoms directly, but may refer patients to allergists when complex comorbidities are involved. For patients who are hesitant to transition to systemic agents, Sher expressed optimism about topical JAK inhibitors, particularly ruxolitinib, for effective itch relief and safety on sensitive areas like the eyelids and face. She cited ruxolitinib’s effectiveness and patient tolerance as significant benefits, describing it as a promising intermediate therapy before systemic options.

Relevant disclosures for Sher include Aimmune Inc, Regeneron, Sanofi Genzyme, and others.

References:

1. Office of the Commissioner. FDA approves New Eczema Drug Dupixent. U.S. Food and Drug Administration. March 28, 2017. Accessed November 11, 2024. https://www.fda.gov/news-events/press-announcements/fda-approves-new-eczema-drug-dupixent.
2. Campbell P. Ruxolitinib Cream offers safe, durable option for patients with atopic dermatitis. HCP Live. October 1, 2024. Accessed November 11, 2024. https://www.hcplive.com/view/ruxolitinib-cream-offers-safe-durable-option-for-patients-with-atopic-dermatitis.
3. Arcutis Biotherapeutics. FDA approves Arcutis’ ZORYVE® (roflumilast) cream 0.15% for the treatment of atopic dermatitis in adults and children down to 6 years of age. Arcutis Biotherapeutics News & Media. July 12, 2024. Accessed November 11, 2024. https://www.arcutis.com/fda-approves-arcutis-zoryve-roflumilast-cream-0-15-for-the-treatment-of-atopic-dermatitis-in-adults-and-children-down-to-6-years-of-age/.