Gaps in Treatment and Approaches for the Pediatric Population with Atopic Dermatitis

Dr. Robert Sidbury (00:14):

My name is Dr. Robert Sidbury, and I am a pediatric dermatologist at Seattle Children's Hospital in the University of Washington in Seattle, Washington. Elaborating on the gaps in the pediatric population, the non-steroidals are fairly limited. We've had tacrolimus and pimecrolimus for 25 years now, but they're not approved under the age of two for pediatric patients. That's when things like steroid phobia are at their peak for both parents and providers, and so that's a considerable gap.

(00:44):

Crisaborole is an option. It is a non-steroidal topical phosphodiesterase inhibitor. It is approved down to three months of age, which is wonderful. It does not have a box warning, which is wonderful, but it has had a fair bit of application site stinging and burning in kids who use it. It sometimes is limited by intolerance.

(01:05):

In terms of systemic medications, the field is even narrower. There's only one systemic medication approved for atopic dermatitis under the age of 12, and that sounds bleak. Compare that to the fact that before 2017 the only systemic treatment for anyone with atopic dermatitis that was FDA approved was prednisone steroids, which are our least favorite treatments. We are in the salad days for treating this disease. But still, under the age of 12, the only FDA approved systemic treatment for patients with moderate to severe atopic dermatitis is Ddupilumab. That is approved down to six months of age, which is remarkable and we are eagerly awaiting some of the other systemic medications as they have ongoing trials in kids younger than 12.

(01:52):

Are there any exciting clinical trials for pediatric patients? It's amazing. If you go to the National Eczema Association website and look at their research page, they have a list of clinical trials that are either phase two, phase three, or beyond, and it's just crazy. Double-digit topical systemics, biologics, orals, it's remarkable. In particular, the medications I'm most excited about at this point are the ones that are farthest along for adults. Things like tralokinumab, lebrikizumab, IL-13 inhibitors that are approved for ages 12 and above. JAK inhibitors, things like upadacitinib, abrocitinib approved for patients 12 and above, nemolizumab, a biologic IL-31 inhibitor approved for kids 12 or patients 12 and above. All of those, unless I'm mistaken, are medications that those companies are looking to expand the indication by doing clinical trials in children. That will be a terrific thing to have even greater options for the pediatric population.