"Significant changes are being brought to atopic dermatitis treatment. which can be described as a 'major shift.' As it is a complex disease with various factors involved, establishing criteria for personalized treatment regarding which therapeutic agent to use for each patient is necessary."

Atopic dermatitis is one of diseases whose treatment landscape has undergone significant changes in recent years.

As atopic dermatitis is a chronic skin condition with complex etiologies, its treatment has historically been challenging. However, the recent emergence of various novel drugs, such as biologics and JAK inhibitors, has diversified treatment options.

During a meeting with Daily Pharm, Dr. Ga-Young Lee, a Professor at Kangbuk Samsung Hospital's Department of Dermatology, stressed the necessity of personalized treatment options for advancing the treatment environment of atopic dermatitis.

"Introduction of new atopic dermatitis drugs offers hope to patients who gave up on treatment due to side effects"

Atopic dermatitis is a chronic skin inflammation caused by a complex interplay of genetic factors, immune dysfunction, and impaired skin barrier function.

Notably, the quality of life issue for patients with severe atopic dermatitis is particularly acute. Because the disease affects the whole body, patients experience severe itching and pain, leading to sleep disturbances and psychological stress, which significantly disrupt their daily lives.

In this context, the shift of the atopic dermatitis treatment landscape with the advent of new drugs is assessed as offering hope to patients.

Dr. Lee explained, "With the emergence of various new drugs, such as biologics and JAK inhibitors, patients who were previously neglected due to side effects from steroid treatments or treatment abandonment are now returning to the hospital," and Dr. Lee added, "Now, diverse treatment options are available, enabling personalized treatment tailored to each patient's condition and needs."

Biologics and JAK inhibitors are two main pillars of atopic dermatitis treatment, with the choice of therapy being made based on patient severity, treatment speed, side effects, and economic burden.

Dr. Lee said, "It's difficult to decide on a single approach, but strategies can vary depending on the patient's severity." Dr. Lee noted, "For severe patients with extensive systemic involvement, injectables are primarily considered, but for those requiring rapid treatment, JAK inhibitors might be more suitable."

For severe patients with an EASI score of 30 or higher and extensive systemic involvement, injectables such as dupilumab or tralokinumab are used. For cases requiring rapid treatment, JAK inhibitors like Cibinqo (abrocitinib) are an option.

Indeed, Cibinqo has shown a rapid onset of action (the time it takes to see treatment effects) in clinical studies.

In the JADE MONO-2 study, 200mg monotherapy demonstrated significantly greater itch improvement compared to placebo within 24 hours of the first dose. The JADE MONO-1 study also demonstrated significant improvement in skin symptoms by week 12 compared to the placebo.

"There are patients who say their symptoms improved significantly within a week or even the very next day after taking Cibinqo, which highlights its fast onset," Dr. Lee stated. "This advantage makes Cibinqo a consideration for those who need quick relief or young adults entering the workforce."

Dr. Lee also said, "Cibinqo showed good efficacy even in cases where symptoms were confined to the face and neck. While there are concerns about herpes as a side effect of JAK inhibitors, Cibinqo has shown relatively fewer side effects, making it safe." She added, "Considering that drug price is also an important factor, the availability of various dosages is a strength of Cibinqo."

Currently, Cibinqo offers three dosage options: 50mg, 100mg, and 200mg, allowing for adjustment based on weight or condition. Dr. Lee explained that patients whose condition is controlled with 200mg can gradually reduce their dosage to 100mg or 50mg.

"For patients with impaired kidney function, even if severe, it's difficult to use high doses, so sometimes only 50mg is prescribed. For lighter female patients or adolescents, high doses may be unnecessary," Dr. Lee said. "In such cases, treatment can be started with 100mg and adjusted down to 50mg. Therefore, having three dosage options is a significant advantage, as it allows for personalized patient treatment."

"Reimbursement criteria of atopic dermatitis has a limitation, expanded criteria for rapid treatment is necessary"

Another change concerning atopic dermatitis treatment is the approval of inter-class switching between biologics and JAK inhibitors. Regarding this, Dr. Lee advised that inter-class switching (between therapeutic regimens) is necessary to ensure treatment flexibility.

Dr. Lee stated, "The current reimbursement criteria for switching therapies only allow coverage when switching between biologics and JAK inhibitors, which doesn't align with clinical practices," and explained, "There are patients who need to switch from biologics to JAK inhibitors, and conversely, there are cases where switching from JAK inhibitors to biologics is necessary."

Especially with the emergence of new atopic dermatitis drugs, personalized treatment should be possible. However, as data have not yet fully accumulated, some consider that improvements are needed to allow for trying and switching to therapies within the same class but with different targets and effects.

"In recent meetings with overseas medical professionals, issues related to switching therapies were raised, and no other country had as restrictive criteria as Korea," Dr. Lee said. "While there may be limitations within Korea's national health insurance system, in my opinion, I believe there needs to be a greater variety of options for drug switching."

Dr. Lee also pointed out that the 'special cases criteria' for atopic dermatitis are excessively stringent compared to conditions like psoriasis.

Dr. Lee stated, "For psoriasis, reimbursement is approved if there's no effect even after 3 months of treatment, but for atopic dermatitis, 'special cases criteria' is only possible for severe patients with an EASI score of 23 or higher," and suggested, "If 'special cases criteria' are applied only to severe patients with a 10% co-payment, mild or moderate patients don't receive treatment benefits. The system should be improved to allow partial reimbursement support for moderate patients as well."

Additionally, Dr. Lee emphasized the need for systematically established treatment guidelines tailored to patient conditions, mentioning the necessity of clear treatment criteria and personalized guidance, including biomarkers and lesion location.

Finally, Dr. Lee stressed, "While the atopic dermatitis treatment landscape is rapidly advancing, continuous management and treatment are currently the main focus rather than a complete cure." Dr. Lee concluded, "With specialized medical professionals, it's important to maintain and improve the patient's quality of life continuously."