Novel treatments for eczema hold great promise


Emma Guttman-Yassky, MD, PhD

The treatment of patients with eczema is on the cusp of a great leap forward thanks to the work of researchers who determined it is a disease of the immune system and identified cytokines as a key component of the disease. These cytokines are the target of two effective treatments expected to be approved by the Food and Drug Administration (FDA) next year.

“In a few years, we will have much better treatments for patients with eczema,” Emma Guttman-Yassky, MD, PhD, said in an interview about her Friday Plenary presentation, “Atopic Dermatitis as an Immune-Driven Disease and Implications for Therapeutics.”

“I think it will be like psoriasis where the treatments will get better and better. Now that we have started in this direction, there will be fine-tuning with good treatments coming into the market. It is a very exciting time because it really is a debilitating disease.”

Two factors slowed the development of more effective treatments of patients with eczema, said Dr. Guttman-Yassky, professor and vice chair of the department of dermatology at the Icahn School of Medicine at Mount Sinai, New York. One was that eczema was viewed as a pediatric disease that most patients outgrew as adults and the second was that it was long misunderstood as being a primarily barrier disease.

“The prevalence of eczema was not known,” she said. “Now we know that eczema patients in the United States represent 3 to 7 percent of the population, and about 15 percent of children. Now, we can imagine how large this population is. About one-third of these are moderate to severe patients, the rest being mild patients.”

Research, in part from the studies of Dr. Guttman-Yassky, determined that eczema is an immune-driven disease and that the elevation of Th2 and Th22 cytokines are the primary culprits for those barrier defects. IL-4 and IL-13 (Th2 pathway cytokines) and IL-22 (the Th22 axis cytokine) are key drivers of the disease and should be considered when developing targeted treatments, she said.

“Many of the characteristics of the barrier defects in atopic dermatitis are actually caused by cytokine activation,” Dr. Guttman-Yassky said. “Once this became evident, it led to the development of treatments that target the activated cytokines.”

The most prominent systemic treatment on the horizon is the biologic dupilumab, which targets IL-4 and IL-13 cytokines. Phase III studies have shown promising results in improving the severity of eczema, she said. The FDA has classified dupilumab as a “breakthrough therapy,” which could help expedite its path toward approval. The drug’s developers are expected to submit dupilumab for FDA approval later this year and it could be approved as soon as the first half of 2017.

In addition, a topical treatment, a crisaborole ointment, has been developed for use by patients with more mild eczema. It blocks the phosphodiesterase 4 (PDE-4) enzyme that has been linked to skin inflammation. Studies have shown that crisaborole is effective in clearing eczema, and it has been submitted to the FDA for approval, which could be approved early next year.

“Atopic dermatitis is undergoing a real translational revolution from the discovery that it is immune-driven and the laying out of the immune pathways that are abnormally elevated in this disease,” Dr. Guttman-Yassky said.I believe that in the next three to five years the treatment armamentarium for eczema patients will be much improved and new treatments that will target specific or broad immune molecules will also be able to revert the barrier defects that are characteristic of atopic dermatitis.”

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