dupilumab

This podcast episode is part of a multimedia program discussing the co-management of moderate to severe atopic dermatitis (AD) in the primary care and specialty settings. Tune in to hear Dr Silverberg and NP Victoria Garcia-Albea highlight newly approved agents and the recent expanded labeling of an existing AD therapy, including: 

• Ruxolitinib, a topical JAK inhibitor for mild to moderate AD approved in 2021 
• Abrocitinib and upadacitinib, oral JAK inhibitors approved in early 2022 for moderate to severe AD
• Tralokinumab, an IL-13 inhibitor available as a subcutaneous injection, which was approved in late 2021 for moderate to severe AD
• Expanded approval for use in patients as young as 6 months for dupilumab, a subcutaneous IL-4 receptor α inhibitor

Presenters: 

Jonathan Silverberg, MD, PhD, MPH
Associate Professor
Director of Clinical Research
Director of Patch Testing
George Washington University School of Medicine and Health Sciences
Washington, DC

Victoria Garcia-Albea, PNP, DCNP, MSN, BSN, PRN
Director
Lahey Dermatology Nurse Practitioner Training Program
Lahey Hospital and Medical Center
Burlington, Massachusetts

To view other program offerings, including a CE-certified recorded roundtable webcast, a ClinicalThought commentary, and to download slides, visit:
https://bit.ly/3PiupXZ

In this podcast, an expert offers his perspective on the role of newer agents in atopic dermatitis—when they’re indicated, how to use them, where they fit on the therapeutic ladder, and adverse effects to monitor for. Also, tips on how to individualize therapy and anticipate adherence issues. The podcast concludes with thoughts on how to address some frequently-asked questions from patients and caregivers. This activity is available for CE/CME credit. Claim your credit at pce.is/AD.

Contributors:

Robert Sidbury, MD, MPH
Chief
Division of Dermatology
Seattle Children's Hospital
Professor
Department of Pediatrics
University of Washington School of Medicine
Seattle, Washington

Morgan Maier, PA-C, BS
Physician Assistant 
Division of Dermatology
Seattle Children's Hospital
Seattle, Washington

Targeted therapies address the underlying pathways that cause airflow obstruction in patients with asthma, including a number of biologic therapies that have been approved. Omalizumab targets IgE (approved for moderate to severe persistent asthma). Three agents target IL-5, which plays a key role in the activation of eosinophils, and are approved for severe eosinophilic asthma: mepolizumab, reslizumab, and benralizumab. Dupilumab targets IL-4/13 and has been approved for moderate to severe eosinophilic asthma or patients requiring maintenance OCS. All agents are available as subcutaneous injections administered at specific intervals, with the exception of reslizumab, which is available as an intravenous infusion. Selection of which biologic agent to use is dependent on multiple factors, including cost, dosing frequency, delivery route, and patient preference among other considerations. The GINA guidelines suggest a biologic agent should be given a trial of at least 4 months; if treatment response is unclear, clinicians should consider extending the trial another 6 to 12 months. If no response is noted, therapy should be changed to another biologic agent. These biologic therapies are generally safe and well tolerated; however, primary care clinicians seeing patients with asthma must be knowledgeable about common adverse events in order to recognize them.

Claim your credit here:
https://bit.ly/3pDx3NI

Contributors:

Lawrence Herman, DMSc, MPA, PA-C
Adjunct Faculty
Doctor of Medical Science Program
University of Lynchburg School of PA Medicine 
Lynchburg, Virginia
President
Palantir Healthcare, LLC 
Boiling Springs, South Carolina

Samuel Louie, MD
Professor Emeritus
Division of Pulmonary and Critical Care Medicine
University of California, Davis
Davis, California

Asthma is now recognized as a heterogeneous, multidimensional disease that involves numerous pathophysiologic factors, including bronchiolar inflammation with airway constriction and resistance. The identification of distinct patient populations (phenotypes/endotypes) is increasingly being recognized as an important strategy for optimizing the management of patients with asthma. Asthma phenotype is based on clinical symptoms such as respiratory function, onset age, and blood biochemical examination values. 

Clinical studies have shown that asthma phenotypes have specific patterns of inflammation that require different treatment approaches. For example, eosinophilic asthma is characterized by airway and systemic markers of eosinophilia, subepithelial fibrosis, and corticosteroid responsiveness, whereas non-eosinophilic asthma is characterized by the absence of eosinophilia and subepithelial fibrosis, as well as poor responsiveness to corticosteroids. In addition to high immunoglobulin (Ig) E levels in up to 60% of patients, asthma is characterized by tissue eosinophilia, which is mediated in part by interleukin (IL)-5. Because eosinophils produce inflammatory proteins that lead to tissue damage, the eosinophilic phenotype of asthma is associated with greater symptom severity, increased risk of exacerbation, and decreased lung function. The GINA guidelines recommend that asthma should be classified by phenotype, especially when it becomes difficult to treat or refractory to treatment.

Claim your credit here:
https://bit.ly/3vUN7Mo

Contributors:

Lawrence Herman, DMSc, MPA, PA-C
Adjunct Faculty
Doctor of Medical Science Program
University of Lynchburg School of PA Medicine 
Lynchburg, Virginia
President
Palantir Healthcare, LLC 
Boiling Springs, South Carolina

Samuel Louie, MD
Professor Emeritus
Division of Pulmonary and Critical Care Medicine
University of California, Davis
Davis, California

Episode Learning Objectives 

· Explore  assessment strategies  based on  disease activity  to guide treatment decisions for moderate to severe atopic dermatitis

· Apply current evidence as well as shared decision-making to  individualize therapy decisions for patients with moderate to severe atopic dermatitis; specifically real world experience around dupilumab (DUPIXENT) and a recent publication exploring  upadacitinib (RINVOQ), an experimental indication for AD vs dupilumab

· Implement strategies to improve interprofessional care coordination between primary care providers and specialty care providers and address the unmet needs of patients

ABOUT DR.ASHLEY O'TOOLE, MHSc, MD, FRCPC:

Dr. O’Toole is a dermatologist with the SKiN Centre for Dermatology in Peterborough, Ontario where she also serves as a sub-investigator for multiple clinical trials. She is an adjunctive professor at Queens University and involved in teaching medical students and residents and holds medical privileges at the Peterborough Regional Health Centre. 

After receiving a Master’s of Health Science in Health and Behavioural Communication at Ryerson University in Toronto, Ontario, Dr. O’Toole received her medical degree from McMaster University in Hamilton, Ontario, and completed her residency in dermatology at the University of Ottawa in Ottawa, Ontario. 

Dr. O’Toole is the author or co-author of over 20 peer-reviewed publications and has been involved ias a sub-investigator for over 40 clinical trials on atopic dermatitis, psoriasis, alopecia, acne and vitiligo.

Disclaimer: This is an educational podcast only and does not replace professional medical advice. Please consult your healthcare provider for any health issues.

Discussed:

• HEADS UP Trial: https://jamanetwork.com/journals/jamadermatology/fullarticle/2782803
• Real-world experience of dupilumab in the treatment of moderate-to-severe atopic dermatitis: https://onlinelibrary.wiley.com/doi/full/10.1111/ijd.15053

 Supported by IMEs from  Janssen and Lilly 

www.skinandjoints.ca