Discussing Changes to Atopic Dermatitis Guidelines, with Robert Sidbury, MD, MPH

At the 2024 Revolutionizing Atopic Dermatitis (RAD) 2024 Annual Meeting in Chicago, Robert Sidbury, MD, spoke with the HCPLive team about his presentation ‘Hot Topic: Guideline Updates From Around the World.’

Sidbury is known for his work as professor of pediatrics for the University of Washington School of Medicine, division chief of dermatology at Seattle Children’s Hospital, and as a co-chair of the American Academy of Dermatology’s (AAD) Atopic Dermatitis Guidelines Committee.

“The reason why guidelines are so important right now for atopic dermatitis is just the explosion of new medications,” Sidbury said. “...For those of us who took care of those patients, it was frustrating and, to put a finer point on that, before 2017 the only systemic medication that was approved for atopic dermatitis by the FDA was prednisone, which are systemic steroids and our least favorite intervention.”

Sidbury noted that, following dupilumab as well as the biologic tralokinumab, lebrikizumab and nemolizumab, all of which are targeting different aspects of atopic inflammation. JAK inhibitors such as upadacitinib have been approved as well, leading to debates about their safety.

“Lots of new medications, which are the reason why an update is important, at least from the standpoint of the American Academy of Dermatology,” Sidbury said. “...It was high time to update, which we did. Also I contrasted the American Academy Dermatology’s guidelines, specifically, with a set of guidelines that the American College of Allergy, Asthma and Immunology and their corollary, the AAAAI group, put together. We use the same system for evaluating the evidence, and actually came up with some different recommendations, which I thought was interesting and worthy of discussion by way of clarification.”

The presence of 2 different sets of guidelines pointing in 2 different directions that implemented the same evidence could be confusing for providers, Sidbury noted. The main element he highlighted was that of the recommendation for topical ruxolitinib, a JAK inhibitor with a boxed warning.

“It's one of the newer topical medications and it's a topical JAK inhibitor,” Sidbury explained. “We both use the same system of evidence, yet the American Academy of Dermatology recommended in favor of its use and the allergy guidelines recommended against…The big point here was that the allergy group had a patient advocate and a patient advocacy group representative of the National Eczema Association. We did not.”

Sidbury highlighted the fact that while the data pointed to favorable efficacy and safety results for ruxolitinib, the boxed warning seemed to dissuade the aforementioned representative who had been included in the American Academy of Allergy, Asthma & Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) group prior to their recommendation against its use. Sidbury stressed that the AAAAI/ACAAI’s decision might have warranted greater contextualization of the boxed warning and the reasons behind it prior to the choice to diverge from AAD’s decision in favor of the drug.

For additional information on the guideline updates, view the full interview posted above.

The quotes contained in this article were edited for the purposes of clarity.