Dr Andy Blauvelt: Drug Approval, Accessibility Challenges in Treating Patients With AD

There have been big advancements in the efficacy and speed for atopic dermatitis (AD) therapies, but there is a lot more room for growth and improvement, says Andy Blauvelt, MD, MBA, president of Oregon Medical Research Center.

Transcript

What challenges do you see in revolutionizing the treatment of atopic dermatitis, and how can they be addressed?

What challenges do I see? So, the biggest challenge I think is getting the drug that I want approved. We know that we live in a cost-controlling medical environment, and many times, insurance companies want us to use the least-costly and sometimes the worst alternatives for the patients.

There's triamcinolone ointment, which can be effective, [and] methotrexate is very cheap, but I actually have experience with topical JAK [Janus kinase] inhibitors, ruxolitinib, which I think works terrific and is a great long-term option for AD patients who have experience with oral JAK inhibitors. You have upadacitinub and abrocitinib, which are terrific drugs, but sometimes hard to get. And the same with biologics, with dupilumab and tralokinumab.

I think one of the hardest things is getting access. What I usually tell dermatologist is not to automatically go with what the insurance company says, if you get that denial. They're going to deny that expensive medicine. But most of the time, if patients have commercial health insurance, we're able to get one of those oral JAK inhibitors or one of those biologics through drug company–sponsored programs.

If you first fail through the insurance company, that's an alternative to get your patients what you want them to get. So, to me, that's really the biggest challenges: to get approval of the things we want to use for our patients.

How do you see the treatment of atopic dermatitis evolving in the next 5-10 years?

We have lots going on in atopic dermatitis research! We had the trailblazer drug dupilumab, and noe we're seeing the advent of oral JAK inhibitors last year, a big advance in terms of efficacy, in terms of effect in itch, and in terms of speed.

I think we're going to be seeing at least 2 new biologics in the near future. We're going to be seeing lebrikizumab and nemolizumab. There's at least 2 that are in phase 3 development that block the OX40 [CD134] and OX40 ligand [OX40L] pathway. This is a way to induce tolerance of T cells or to stun T cells and keep them from becoming activated. We're going to see probably drugs in that pathway be approved in the next several years. We're going to probably see additional oral treatments of other classes other than JAK inhibitors.

A lot is going on. We still have a lot of room to improve. We know now that things that we had hoped for, with IL-13 [interleukin-13] blockade, we had hoped that it would turn into a grand slam winner and have high levels of disease clearance. Not quite there with selective IL-13 blockers. So, we know that there's room to go in terms of both efficacy and safety of treatments for AD.