Brian S. Kim, MD: Prioritizing the Patient in Dermatology Innovation

The American Academy of Dermatology (AAD) Annual Meeting is among the foremost opportunities to regularly disseminate and celebrate breakthroughs in skin health science; in the last decade, its agenda—and causes for excitement—has grown greatly with the introduction of new systemic therapies, pathway-targeting agents, and gene and cell therapies.

Relative to the former standard for innovations and breakthroughs, dermatology is looking more clearly into its future than ever before. At AAD 2024, HCPLive spoke with one of the experts who helped inform that future.

Brian S. Kim, MD, vice char of research at Mount Sinai West and director of the Mark Lebwohl Center for Neuroinflammation and Sensation, is a pioneer investigator into the interleukin-4 (IL-4) receptor signaling traits that which helped inform the clinical development of dupilumab (Dupixent). He also was among the leading investigators into the impact of Janus kinase (JAK) inhibitors on signaling to inflammatory and non-inflammatory itch in atopic dermatitis.

When asked what the breakthrough of JAK inhibitor and systemic therapies into chronic skin disease like atopic dermatitis has done to help the field better understand dermatologic disease, Kim said he has a better appreciation for the level of burden patients withstand before getting adequate care.

“I don't think we recognize how much patients were suffering until they actually got to a level of recovery where they knew what it was like to live a fairly non-atopic dermatitis life,” Kim explained.

He also said the advent of this new wave of targeted therapies have improved the overall standard of treatment safety—“we can actually improve outcomes without always making things more risky or having adverse events.”

“Some of these agents are quite safe in atopic dermatitis,” Kim continued. “Some, we have to be a little bit more cautious about, but we know that you can have high efficacy and high safety. And I think increasingly in the future, we'll see that a lot more.”

On the subject of prioritized clinical outcomes in the research of these new drugs, Kim stressed there’s need to be a better acceptance of what the true role of a prescribing dermatologist should be. While caregivers in fields like cardiometabolic disease and oncology are largely tasked with bettering patient longevity, dermatology should focus on the improvement of life quality.

“I think that patient reported outcomes are very important, and I don't think we should compromise that for the sake of say, objectivity, if that makes sense,” Kim said. “And I'm obviously biased but I think, for instance itch is very, very important. It's a subjective measure, but it's very important. And at the end of the day, quality of life is a subjective measure.”

Kim described a hypothetical in which a patient with eczema is scoring a 2 on their Investigator Global Assessment (IGA) scale, but a maximum score for itch symptoms. The standards of the field would state that patient does not have severe disease.

“To me, that's a complete paradox when the central symptom of atopic dermatitis—that absolute requirement for its diagnosis and the measure of disease in many ways—is actually going to be itch,” he said. “If you're not comfortable, it doesn't matter what the provider thinks.”