The Future of Atopic Dermatitis: Comparative Studies, Biomarker Testing

The atopic dermatitis treatment landscape is evolving. Amid extensive research and new therapies, Dr Nikolaos Sideris and coauthors conducted a review of current literature and incoming treatment options to shed light on the current state of practice.

In this interview with First Report Managed Care, Dr Sideris emphasizes the importance of comparative trials and individualized treatment approaches as the field continues to change.

What existing data led you and your coinvestigators to conduct this review?

Every aspect of research in dermatology is blooming right now, from basic science to phase 4 trials for various agents. Several pathophysiological pathways are newly discovered or better understood, and consequently targeted with diverse kinds of molecules. For example, a search in clinicaltrials.org registry for psoriasis, atopic dermatitis, and alopecia areata yields more than 2000, 1500, and 1000 results, respectively.

Skin has the additional particularity that it can be targeted by both systemic and topical treatments, so that doubles the options.

It is very difficult for a busy clinician to stay up to date. We tried to summarize current knowledge about recently approved and upcoming topical treatments for atopic dermatitis, for clinicians of all specialties involved in the treatment of the disease, and for anyone else interested in the topic.

Please briefly describe your review and findings. What are the key takeaways?

We tried to be as thorough as possible since the amount of information is overwhelming. We did not only search medical literature databases, but also gray literature and information for the general public. We used every single topical agent in the American and European clinical trials databases as a search term, both in medical databases and search engines.

I think the most important takeaway is that the future is brilliant! Soon, clinicians will have many more options in their arsenal to fight atopic dermatitis according to disease phenotype, immunologic profile, or other aspects that remain to be identified. In the next years, targeted treatment is the direction that medicine will move in.

Another takeaway is that today, more than ever, clinicians should devote some of their time to studying and remain informed. Developments in medicine are happening faster than ever, and continuing education is essential for physicians who do not want to fall behind.

Where do you see the future of care headed as more atopic dermatitis treatments are developed?

There is an ongoing revolution in therapeutics right now that started some years ago with the first biologic agents. We dermatologists and our patients are lucky to be in the epicenter. Countless biologics and small molecules are being trialed, and the landscape changes literally month-by-month. Maybe even week-by-week would not be an exaggeration, considering the accelerated research around many diseases other than atopic dermatitis, including major dermatologic diseases like psoriasis, vitiligo, hidradenitis suppurativa, cutaneous lupus erythematosus, alopecia areata, etc.

As with all revolutions, a level of confusion is expected in the beginning. Transitioning from 2 available options, corticosteroids and calcineurin inhibitors, to dozens of new topical and systemic treatments is not easy. Some uninformed decisions will be made by clinicians, but not unexpectedly since there are many more things that we need to learn.

To address those issues, in the next years, researchers and clinicians should gather and publish a lot of high-quality, real-life data. The industry rarely conducts comparative studies, so this is also something we should do. Being new does not necessarily mean being better, so all those new treatments should be compared with old ones and with one another.

Another very important step is to find the best treatment for each disease subtype. Every patient is different, and countless factors affect the disease phenotype, from simple things like age and sex, to more complex ones like filaggrin mutation status, IgE and various interleukin levels, and many more. Biomarkers, another field of extensive research, will also help us move in the direction of targeted treatment by predicting relapses, disease extent, and treatment response.

Is there anything else pertaining to your review and findings that you would like to add?

Most of the data presented in our review have been sourced from clinical trials. In those, conditions are more controlled, with patients chosen according to various criteria and intensively observed throughout the duration. For these reasons, sometimes we see different results in real life than those expected based on trials. I would like once more to highlight the importance of reporting comparative and real-life data in the upcoming years, until each new agent takes the place it deserves in the treatment of atopic dermatitis.

About Dr Sideris

Nikolaos Sideris is a private practice dermatologist-venereologist in the town of Servia, in northern Greece. He also works as a PhD candidate-scientific associate in the First Department of Dermatology, Medical School of Aristotle University, in Thessaloniki.

He has been lucky enough, from day one of his residency, to work in a great environment, full of internationally renowned experts in various dermatologic fields. His teachers strengthened his pre-existing love for every aspect of dermatology. His work is now more focused on inflammatory diseases, including their pathogenesis/immunologic background and comorbidities.