Atopic dermatitis, dermatology

1. RECENT ADVANCES IN ATOPIC
DERMATITIS MANAGEMENT
Dr Rashmi Sharma
2nd
year MD Resident
Institute of Medicine, Tribhuvan University
July 21, 2017
Dr Rashmi Advances in Atopic Dermatitis

2. Biological Therapies:
Monoclonal Antibodies
Chimeric antibodies: Infliximab, Rituximab, Basiliximab
Humanised antibodies: Omalizumab, Efalizumab
Fully Human antibodies: Adalimumab, Ustekinumab
Fusion antibody protein:
Etanercept, Abetacept
Recombinant human cytokines and growth factors:
Interferons, GM-CSF, PDGF
Dr Rashmi Advances in Atopic Dermatitis

3. Role of anti-TNF-α
No evidence to support the efficacy of Anti-TNF alpha therapy
in atopic eczema.
Dr Rashmi Advances in Atopic Dermatitis

4. Emerging treatments
Table 1: Emerging treatments for atopic dermatitis
Name of agent Route Mechanism Phase
Dupilumab SC Anti-IL-4Rα mAb
(blocks both IL-4
and IL-13 activity)
III
Lebrikizumab SC Anti-AL-13 mAb II
Tralokinumab SC Anti-IL-13 mAb II
Secukinumab(Cosentyx) SC Anti-I-17A mAb II
Omalizumab SC Anti-IgE mAb II
Ligelizumab (QGE031) SC Anti-IgE mAb II
Dr Rashmi Advances in Atopic Dermatitis

5. Omalizumab
Recombinant humanised monoclonal antibody against IgE
Binds IgE at the same site as its high-affinity receptor,
Fc R I causing reduced binding of IgE to Fc R I.
Effects:
Reduced free serum IgE
Lowered surface IgE and Fc RI expression on different
peripheral blood mononuclear cells,
Reduced saturation of Fc RI with IgE,
Increased number of free Fc RI
Dr Rashmi Advances in Atopic Dermatitis

6. Omalizumab: Contd.
20 atopic dermatitis patients
Omalizumab/ placebo for 16 weeks
Immunological and clinical disease parameters measured
Therapeutic benefit of omalizumab treatment,would be seen in
patients with acute rather than chronic forms of the disease. 1
1
Heil PM et al. J der Dtsch Dermatologischen Gesellschaft. 2010
Dec;8(12):990-8.
Dr Rashmi Advances in Atopic Dermatitis

7. Omalizumab: Contd.
28 week trial on 20 mild to moderate atopic dermatitis
patients2
Patients with absence of fillagrin gene mutation can
benefit from Anti- IgE treatment.
Altered lipid metabolite profiles with high levels of various
glycerophospholipids.
2
Hotze M et al. Increased efficacy of omalizumab in atopic dermatitis
patients with wild-type filaggrin status and higher serum levels of
phosphatidylcholines. Allergy. 2014 Jan;69(1):132-5.
Dr Rashmi Advances in Atopic Dermatitis

8. Rituximab
6 patients two infusions of 1000 mg 2 weeks apart
Dr Rashmi Advances in Atopic Dermatitis

9. Dupilumab
Antibody to α-subunit of the IL-4 receptors that blocks
IL-4 and IL-13 signalling.
Showed clinical efficacy in persistent asthma with
elevated eosinophil levels3
Patients treated with dupilumab had marked and rapid
improvement in all the evaluated measures of atopic
dermatitis disease activity.
3
Beck LA et al. Dupilumab Treatment in Adults with
Moderate-to-Severe Atopic Dermatitis. N Engl J Med. 2014 Jul
10;371(2):130-9.
Dr Rashmi Advances in Atopic Dermatitis

10. Lebrikizumab
Monoclonal antibody to interleukin-13
Shown efficacy in atopic asthma4
Under active development
4
Corren J et al. Lebrikizumab Treatment in Adults with Asthma. N
Engl J Med. 2011 Sep 22;365(12):1088-98.
Dr Rashmi Advances in Atopic Dermatitis

11. Emerging therapies
Table 2: Emerging therapies for atopic dermatitis(PDE-4I)
Name of
agent
Route Mechanism Phase
Apremilast PO PDE-4 inhibitor(small molecule) II
Roflumilast Topical (cream) PDE-4 inhibitor(small molecule) II
Crisaborole
(AN-2728)
Topical (ointment) PDE-4 inhibitor(small molecule) III
E6005 Topical (ointment) PDE-4 inhibitor(small molecule) II
OPA-15406 Topical (ointment) PDE-4 inhibitor(small molecule) II
DRM-02 Topical (Gel) PDE-4 inhibitor II
LEO29102 Topical (cream) PDE-4 inhibitor II
Dr Rashmi Advances in Atopic Dermatitis

12. PDE-4 Inhibitors
Apremilast : PO molecular inhibitor of PDE 4
Sixteen adult patients with atopic dermatitis5
.
2 doses of apremilast
Topical phosphodiesterase (PDE) inhibitors
5
Samrao A et al. A Pilot Study of an Oral Phosphodiesterase
Inhibitor (Apremilast) for Atopic Dermatitis in Adults. Arch Dermatol.
2012 Aug 1;148(8):890-7.
Dr Rashmi Advances in Atopic Dermatitis

13. THANK YOU
Dr Rashmi Advances in Atopic Dermatitis