Finding the Right Medication for the Right Patient with Atopic Dermatitis

Dr. Justin Marson (00:07):

Hi, I'm Dr. Justin Marson. I completed my residency at SUNY Downstate in Brooklyn. So I think we're very fortunate now in dermatology that we have this problem that we now have too many effective medications, starting with things like dupilumab, tralokinumab, lebrikizumab, nemolizumab, upadacitinib, and so many more coming down the pipeline of systemics that are very safe and really need not as much drug monitoring as some of the older medications.

(00:34):

In terms of finding the right medication for the right patient, I think, again, it comes down to the drug the patient's going to use is going to be the best medication regimen for them. Someone who's very needle phobic, maybe I'll start with a JAK or a stat. If there's someone who they prefer to have longer dosing regimens, there's studies that tralokinumab, you can start spacing it out after a certain month, about four months of the Q2 week dosing.

(01:01):

But certainly, another thing to consider is that, at least within our healthcare system, certainly some drugs need to be tried first. So at least during my residency, dupilumab was one of the drugs we had to go through first. And for many of our patients, they did well enough that they might not have wanted to switch going forward. But I think having that open conversation about how patients are doing on the regimen, and if there's anything they feel like they could improve, goes a long way.

(01:28):

The first drug you choose might not be the last. Going forward, I think it's also important to have ongoing dialogue with our patients to see, do their needs change? Do their experience of one medication change? Do they want to try something, either like less frequent dosing? At that point, you can always adjust course. So again, my take-home is that the best drug for the patient is the one they're going to want to use.