Transcript
Announcer:
This is DermConsult on ReachMD. On this episode, Andrew Mastro, a board-certified physician assistant at the Illinois Dermatology Institute and DeNova Research in Chicago, will discuss how he sets expectations with patients starting topical JAK inhibitors for atopic dermatitis. Let’s hear from him now.
Andrew Mastro:
I really do think it's important to talk about itch right from the get-go because a lot of times, you're breaking these people off of a TCS and they're used to that immediate itch relief, and so you have to rewire that concept that they can't experience that with another topical.
I like to reframe results around my follow-up times because when I bring them in, I want specific points of wins that we can celebrate together or challenges that we can address together. And so essentially, what I say is, “Within the first few days, even beyond the first 15 minutes, your itch will start improving. So it's just a matter of just hedging it a little bit. You could have that really quick result by the time you get home. But really, by tomorrow or the next few days after that, your itch should start to turn a little bit. And then that should continue within the first couple weeks, and then extend by the time you come to see me in one month,” because I see them one month after starting. I also say, “The skin should start to look better when we're in that few weeks, but it really should start to turn by the time you come back in here in that four-week mark. So that itch and the sensation you're feeling should start to jive a little bit before your skin starts reflecting what you're feeling.”
But I also let them know this therapy was tested out to eight weeks. Why does that matter for any of us? Because when I look at data, I'm looking at it across that landscape to that endpoint of eight weeks for this therapy, for example. However, I like to look at, what are my four-week time points? What are my six-week time points? Because we usually are seeing patients either at four, six, or eight weeks after we start them on a topical AD therapy. So why that's important is that you want to be able to predict how a patient is potentially going to feel by the time they come see you in your chair. So when they come in and you expect them to be better, and they tell you that they are, that's a win. And why that matters is because you're building rapport. You're building rapport with that patient that's going to extend multiple months or multiple years, because this stuff is not going away.
You also want to bring them in at the time when you feel you may need to make an alteration or change. So at the four-week mark, I bring them in because I want to necessarily see the itch and the skin improving at that time point, so I give that as the expectation. But then I will tell them, "Hey, you know what? By the next visit after that, you're going to come see me in a couple months after that because I want to see how you're now moving into the future over a long-term use." And at that point, that's when we can one, make sure that they're adhering onto therapy, two, celebrate a long-term win, and three, adjust therapy at that time and potentially go into a systemic therapy or switching topicals. I can address it at that time.
I also live in Chicago, which means that if I see them in January, it's going to be cold out here. So if this is May, their AD might be reflecting a lot differently, so we have to also take that into consideration as well. When do we actually see them in their life and in seasonality?
So that's how I like to do it, and everyone is very different. But I don't like to have these whimsical follow-ups. I set the expectations appropriately based on data, based on anecdotal experience, and based on when I can celebrate those wins and address the challenges.
Announcer:
That was Andrew Mastro sharing his perspective on setting expectations with patients who are starting atopic dermatitis treatment. 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!
