2 Additional Clinical Pearls for Dermatologists, with Eingun James Song, MD

An interview at the 44th Annual Fall Clinical Dermatology Conference in Las Vegas was conducted between the HCPLive editorial team and Eingun James Song, MD, associate chief medical officer and director of clinical research at Frontier Dermatology.

Song contributed 4 clinical pearls to a panelist talk at the conference titled ‘20 Tips in 20 Minutes.’ In this segment of his interview, he discussed the latter 2 tips and then the broader implementation of them into clinical practice.

“The third tip is using upadacitinib,” Song explained. “This is an oral JAK1 inhibitor for refractory dermatomyositis. We know that dermatomyositis could affect many different organ systems, including the skin, the muscles, and the lungs. And there's actually been a number of studies that have looked at various different oral JAKs, whether it's upadacitinib, ruxolitinib, or barcitinib.”

Song noted that what has been consistently observed is that these JAK inhibitors work quite well for the skin, but also for lung improvement, lung function improvement, and even overall survival.

“A lot of these patients, unfortunately, pass away because they get rapidly progressive interstitial lung disease,” Song said. “And we do now have some data to suggest that using oral JAK inhibitors could actually improve, not just a quality of life for these patients, but also the actual mortality benefit in using these drugs as well.”

Next, Song highlighted several acantholytic disorders which can be treated using biologic medications and JAK inhibitors. He noted that some of the skin barrier defects associated with such conditions as Hailey–Hailey disease, Grover's disease, or Darier disease can give way to type 2 inflammation.

“And that type 2 inflammation then can affect calcium mobilization and keratinocytes, which can affect desmosomal integrity,” Song said. “So we've had some success using biologics like tralokinumab and dupilumab to target that type 2 inflammation, and in those refractory cases, we even use oral JAK inhibitors to treat pretty much all 3 of those conditions.”

Given these drugs’ success for such conditions, Song urged attendees that when they are running out of options for such patients, to think about biologics that target type 2 inflammation and oral JAK inhibitors as well. Later, he was asked about unmet needs for the patients he covered in his talk.

“The reality is, for these conditions, they don't have many FDA-approved therapies and we often refer to them as orphan disorders because they’re fairly rare and there's very little in the way of actual approved medications,” Song said. “In dermatomyositis, for example, the only FDA-approved treatment is intravenous immunoglobulin or IVIG. We don't have anything FDA-approved for Hailey Hailey, Grover’s, or Darier, so everything that we do is off-label.”

The need for US Food and Drug Administration (FDA)-approved therapies is, Song explained, consequently more apparent. He added that the hope is that reports of these cases’ success with these therapies may influence or convince some industry partners to take on these types of studies and do it for these types of diseases.

For additional information, view the full interview above. To find out more about conference talks, view our latest conference coverage here.

The quotes used in this summary article were edited for clarity.