Transcript
Announcer:
You’re listening to DermConsult on ReachMD. On this episode, Dr. Peter Lio will discuss safety considerations in atopic dermatitis care. Dr. Lio is a Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine and a dermatologist at Medical Dermatology Associates of Chicago. Let’s hear from him now.
Dr. Lio:
The safety discussion has changed a lot in the past few years. I think the biggest thing for us is that we now have biologic agents, and of course, at this time, we have four biologics that are approved for atopic dermatitis: dupilumab, tralokinumab, lebrikizumab, and nemolizumab. And it is fantastic to have these. They're extremely targeted. The safety profile on them, again, is not nothing. I wish I could say they had no safety issues. They all have some safety issues and tolerability issues, but compared to their efficacy, it is really something quite different than what we had before because prior to these, we were using old immunosuppressants—these broad immunosuppressants that were brought in because it's all we had—things like cyclosporine, methotrexate, azathioprine, mycophenolate, and of course, systemic corticosteroids.
Now, all of those can help many patients; they really can and have. They have long histories of helping. They have a tremendous list of safety things we have to discuss. When we look at methotrexate, it has multiple boxed warnings. So those, I think, were very different. We tried to minimize their use. We had to do lab monitoring. With the biologics, it sort of opened the door. We don't have to do blood work or testing like that. Many patients have been on it for years, and now we're approaching even a decade of use for dupilumab, which has been out since 2017 in the United States. So really exciting to see this and of course, even in multiple age groups.
Now, we also have some more powerful medicines like the JAK inhibitors. We have abrocitinib and upadacitinib, the oral JAKs, and those do have a little bit more safety issues, so we do have to have the safety discussion. On the other hand, the bad news is that I think we've had more concerns about topical corticosteroids and more patients bringing this up, and there's a movement against steroids by a lot of patients and patient groups. So our job, I think, is not to necessarily push against that or try to fight that—I don't think that's the appropriate way—but really to try to educate. And what I’d say is trying to be a good steward of topical steroids because I want people to still be able to use them. They're incredibly effective. They're generally safe when used correctly, and they're very accessible, and that's the secret. They're very cheap, so we can get them for almost anybody.
So trying to find the right balance and thread the needle, being transparent and open and honest with families, not dismissive, because I find a lot of my patients are frustrated and angry when they come in. They say, "Everybody keeps saying just more steroids, and they're totally safe. Don't worry." And I'm like, "Well, I'm not going to say that. I promise you I'm going to say something different." But we have to have a sober safety discussion and talk about why, to some degree, everything is dangerous. We have to be relative.
Announcer:
That was Dr. Peter Lio discussing the safety of evolving treatment approaches for atopic dermatitis. 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!
