August's Condition Watch focuses on skin health.
Listening to the experiences of patients and caregivers is crucial when treating pediatric atopic dermatitis (AD), according to experts in a session at the 2023 Asembia Specialty Pharmacy Summit. AD is a long-term skin condition characterized by an inflamed and pruritic rash that tends to wax and wane. Flares can be worsened by factors such as patient-specific allergens, and it occurs most commonly inside the elbows, behind the knees, and in the front of the neck.
Notably, the full impact of AD cannot be estimated based on skin signs alone. Sleep disturbances are common and increase with disease severity. On average, children with mild to moderate AD lose 50 minutes of sleep per night, and 60% of caregivers wake up a minimum of 2 times per night to care for their child with AD.
Caregivers also report heightened anxiety due to conflicting treatment and management recommendations, as well as concerns about adverse effects and worry about the child’s well-being. Quite a few topical treatments are available. Presenter Alyssa Wu, PharmD, BCPPS, AE-C, a clinical pharmacist at Rady Children’s Hospital–San Diego, said ointments are preferred, followed by creams and lotions, but she emphasized that whatever the child will tolerate is acceptable. For example, high school–aged children may refuse greasier options, such as petroleum jelly (Vaseline), because of social embarrassment, so lotions may be a better option.
Nontopical treatments are also well established. Oral antihistamines are an option, although it is important to consider sedating versus nonsedating options. These can primarily be used to help with nighttime itching to improve sleep quality.
The efficacy of upadacitinib (Rinvoq, AbbVie) was maintained for 3 years in patients with psoriatic arthritis (PsA) who previously had an inadequate response or intolerance to 1 or more non–biologic disease–modifying antirheumatic drugs, according to study results.
Upadacitinib improved symptoms of PsA compared with adalimumab (Humira, AbbVie) through 104 weeks in the SELECT-PsA 1 trial (NCT03104400). Additionally, after 3 years, no new safety signals were identified.
Participants who received upadacitinib had greater 20%/50%/70% American College of Rheumatology criteria responses and minimal disease activity responses compared with adalimumab. Patients in the upadacitinib arm also had a greater mean change from baseline in Health Assessment Questionnaire–Disability Index, the patient’s assessment of pain, and Bath Ankylosing Spondylitis Disease Activity Index.
“We offer 2 important insights from this study. The first is that the number of [individuals] with a beneficial response to upadacitinib, meaning patients who experienced improvement and reached minimal disease activity, after nearly 3 years was generally consistent [with] the number of patients who responded after 2 years. We also observed that the overall safety profile for upadacitinib remained unchanged and that there were no new safety signals,” said first author Iain McInnes, PhD, FRCP (Gla), FRCP (Edin), FRSE, FMedSci in a statement.
At least 70% of adult or adolescent patients with moderate to severe atopic dermatitis (AD) achieved improved or cleared skin with lebrikizumab, according to results from a phase 3 clinical development program (ADvocate 1, ADvocate 2, and ADhere studies).
In ADvocate 1 (NCT04146363) and ADvocate 2 (NCT04178967), 80% of patients experienced a 75% change from baseline based on the Eczema Area and Severity Index (EASI) score. These changes lasted up to a year. In the ADhere study (NCT04760314), lebrikizumab was shown to improve the EASI score with or without the addition of topical corticosteroids.
“These data suggest lebrikizumab may improve the signs and symptoms that many patients with AD experience and are particularly meaningful for those who are in urgent need of new approaches to treating this disease,” said Karl Ziegelbauer, PhD, chief scientific officer at Almirall SA, in a press release.
Almirall and Eli Lilly and company are codeveloping lebrikizumab. Lebrikizumab is a novel investigational monoclonal antibody that blocks IL-13 to decrease itch, skin thickening, and susceptibility to infection.