Transcript
Announcer:
Welcome to DermConsult on ReachMD. On this episode, Dr. Peter Lio will explain why clinicians are treating moderate-to-severe atopic dermatitis earlier. He’s a Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine and a dermatologist at Medical Dermatology Associates of Chicago. Here’s Dr. Lio now.
Dr. Lio:
I think there are two big drivers for wanting to treat disease earlier and earlier. The first one is that we understand that, to some degree, the amount of suffering people experience is cumulative, and there's an area under that curve. So for somebody with maybe even more mild disease for many years, that's a huge impact over time, right? You have to add that up. Every day they've been a little bit bothered for 20 years, that's still a lot of suffering. And of course, for moderate and severe disease, you can magnify that and amplify that by manyfold for some patients. So part of it is just decreasing the overall suffering a patient has to undergo.
Part of it is that we understand, particularly in children and adolescents, there are important life milestones that come up. And if you are miserable and bleeding and bedridden, some of my patients are that severe have missed grade school or high school or graduation or important events. They've not been able to socialize. So all these pieces really are what we might say is a one-way door. You can't go back. You can't go back and repeat third grade, generally speaking. So you really are thinking about it that way.
But that is only the beginning. The truth is now we also believe—at least I believe pretty strongly, and I know some of my colleagues do as well—that we have the potential to modify the disease. And what I mean by that is if we catch it earlier, it really does seem like not only can we prevent some of that suffering, but we might actually be able to shape the outcome a little bit differently, such that the overall severity seems to be lower to the point where I honestly have a whole group of patients—and I've written this up before—who were extremely severe and uncontrolled. We got them under great control, usually using a biologic agent. After a time, though, they were so stable for so long that when we decreased and even stopped the biologic agent, they stayed pretty clear. So we really feel like we could shape the outcome of the disease and potentially modify it, getting them to a form of remission.
And then we also have this being true with some of the comorbidities. There's the potential that we can decrease the incidence of things like food allergies or environmental allergies. We know there was data published just about a year and a half or two years ago with dupilumab. Children who took dupilumab actually were taller. They got more vertical height than a control group that didn't. Now, that doesn't mean we think that dupilumab makes you grow. We just think that when your body is fighting off this terrible inflammation, you're under constant stress, you're not sleeping well, and you literally don't grow as well. It may also have to do with the amount of corticosteroids, and we know those can suppress our vertical growth. So by getting them on the appropriate treatment and getting them healed, we can say that they really did grow more. And again, that is another one-way door. If you miss your time to grow, after a certain point, that's it. The growth plates fuse, and you stop having the ability to grow taller.
So all of these pieces, I think, converge on the idea that we want to try to catch it earlier, we want to be more aggressive, and we truly believe that everybody wins when we do that. We use less medicine overall. For the disease itself, suffering is minimized. And the potential for comorbidities and other allergic and potentially even non-allergic issues is possibly, even likely, decreased.
Announcer:
That was Dr. Peter Lio discussing the rationale behind treating atopic dermatitis early. To access this and other episodes in this series, visit DermConsult on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!
