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Biologic Agents
The eczema pipeline includes a number of biologic agents that target new cytokines, IL-13 and IL-31. In this video, April Armstrong, MD, MPH, discusses what is known about these emerging options for atopic dermatitis. Dr Armstrong is professor of dermatology and associate dean of clinical research at Keck School of Medicine of University of Southern California in Los Angeles.
Transcript
Dr Armstrong: When we think about atopic dermatitis and the different mechanisms that are implicated, we typically think about the TH2 pathway. The targets that have been the subject of investigation in terms of drug development have mostly been in IL-13, IL-4 as well as IL-31. Lately, the key target that has been used in terms of the drug development is IL-13. IL-13 is thought to be important in terms of not only mediating what we see clinically on the skin but also important for mediating the itch that our patients experience.
In addition to that, IL-31 also had been important in terms of itch mediation, not only just in terms of atopic dermatitis but also in a number of different disease states.
IL-33 is one molecule that we are continually trying to understand with regards to its role in atopic dermatitis. It's thought to be important when at excess levels, responsible for disruptions in skin barrier as well as mediating itch.
We're living at a very exciting time for atopic dermatitis in terms of treatment development. There are a number of different therapies. With regards to the biologic therapy, things that are in more late-phase development are things like nemolizumab, which is IL-31 inhibitor, lebrikizumab, which is IL-13 inhibitor, and importantly, tralokinumab, which is also an IL-13 inhibitor, which is probably in terms of the latest-phase development.
With regards to tralokinumab, which is IL-13 cytokine-blocking agent, it is dosed at Q2 weeks, but possible there could be a Q4-week dosing regimen. Its pivotal trials have shown that around 22% of the patients achieved clear or almost clear at week 16. It's a biologic that will offer another option. Can it be used as a first-line biologic? It can be. There's no reason why it cannot.
In addition to that, for patients, for example, who do not tolerate dupilumab, which is a medication that has revolutionized atopic dermatitis treatment, but there are a proportion of patients who may not respond as well or may experience AEs, this is something that one can try, tralokinumab, which is more targeted towards the IL-13 cytokine.
It does have a slightly slower onset of action. What is noted is that its mechanism of action is perhaps partially responsible for some of the long-lasting effects that we're seeing with tralokinumab and also continued improvement after week 16. What we see is an increase in terms of response rate, even after week 24, in a subset of patients.
In terms of tralokinumab in combination with topical steroids, and this is used in the setting that's more mimicking the real world, what we see in terms of the clear or almost clear response is, more around the range of 39% of patients on tralokinumab plus topical steroid by week 16 would achieve clear or almost clear.
In summary, in terms of tralokinumab, no reason that it cannot be used as a first-line systemic agent, for patients who had been on dupilumab who maybe have not responded as well or who have experienced side effects, tralokinumab could be another option that could be very appropriate for those patients.
