Advancing Pediatric Dermatology Biologics and Symptom Scoring

The field of systemic therapy for pediatric atopic dermatitis is not yet brimming with options—but give it a few months.

In the final segment of an interview with HCPLive during the American Academy of Dermatology (AAD) 2022 Annual Meeting in Boston, Amy S. Paller, MD, Chair of the Department of Dermatology at Northwestern Feinberg School of Medicine, hit on the anticipated agents that could join dupilumab (Dupixent) as viable biologic and systemic therapy options for more severely impacted pediatric and adolescent patients.

First, Paller shared interest in the pending regulatory review and decision for tralokinumab, which as an interleukin 13 (IL-13) inhibitor already includes promising adolescent-level data for atopic dermatitis, and may offer a unique benefit relative to the IL-13 and IL-4 inhibitor dupilumab.

“It may be an alternative for those who maybe have conjunctivitis—there may be a little less signal for the conjunctivitis if you’re just targeting the IL-13, but that remains to be seen,” Paller said.

Upadacitinib, which is already available, is a viable second-line option after biologics failure, Paller noted. “And there are going to be needle-phobic patients,” she said. “I think we have to consider the possibility of using it—at least short-term.”

The treatment does carry a Boxed Warning, so dermatologists will need to navigate the discussion of safety outcomes with parents and guardians of pediatric patients. Regardless, Paller is pleased with the available data for that, as well as for abrocitinib.

“We’re going to have a lot of options for our patients both oral and injectable within the next year or so, and we’ll get a lot of experience from that,” Paller said. And then there are new ones coming out beyond that, that we’ll need to see with our adolescents and children.”

And with the armament of potent, diverse therapies become more quickly available, Paller stressed the need for quantification of benefit—with simplistic metrics that could help dermatologists compare efficacy and safety of one agent to another in the same patient visit.

“It’s very important that we are able to assign severity to meet the requirements to be able to get these new medications for treatment, and one thing I’m very much touting right now how easy it is to quickly get an Investigator Global Assessment (IGA) and Body Surface Area (BSA) and do the multiplication—because the IGA times BSA is a new score that is virtually identical to the EASI score, which of course takes so much more time to do,” Paller said.