The treatment landscape is undergoing significant changes as new drugs for atopic dermatitis, including biologics and JAK inhibitors, have emerged over the past few years.

Experts assess that patients who gave up on receiving treatments due to recurrence and side effects are revisiting hospitals with the introduction of new drugs.

As treatment options become diverse, the primary concern for the clinical field is 'what' treatment to use.

During the meeting with DailyPharm, Professor Seong Jun Seo of Soon Chun Hyang University Cheonan Hospital's Department of Dermatology emphasized the importance of personalized treatment tailored to each patient, along with consideration of economic factors.

More treatment options to treating atopic dermatitis…"personalized treatment is key"

Atopic dermatitis treatment options have expanded beyond the previous standard therapies, which include moisturizers and topical steroids, to two types: biologics and oral JAK inhibitors. Currently, three biologics and a JAK inhibitor are listed for reimbursement in Korea.

Professor Seo advises that personalized treatment, based on patient characteristics, is key as treatment options continue to expand.

Professor Seo said, "In my opinion, criteria for selecting a treatment should be based on the patient's condition and needs, and that 'the best drug should be the first one used'," and stressed, "It is crucial to provide the best treatment option for each patient from the very beginning."

For example, for patients with atopic dermatitis who also have other allergic conditions (such as asthma or rhinitis), or those who are elderly or have chronic diseases, a biologic with a lower burden on the systemic immune system is considered first. In contrast, for patients who desire a quick effect or have a strong fear of injections, an oral JAK inhibitor is used first.

This means that a personalized treatment, which considers both treatment goals and patient preferences, is key to treatment success.

However, in reality, insurance criteria are a stumbling block. Under the current National Health Insurance's Special Case Medical Expense Coverage criteria, new drug treatment is limited to severe patients (EASI score ≥23, BSA ≥10%).

This leaves moderate patients in a reimbursement blind spot, and experts unanimously agree that this needs to be improved to widely support personalized treatment.

Professor Seo also pointed out that "more flexible criteria are needed, such as giving weighted scores to lesions on areas that significantly affect quality of life, like the face and neck, even if the EASI score is below 23."

One Year After Adtralza's Launch…Patients are more satisfied with improved safety and facial flusing

In this situation, the evaluation from the field is that Adtralza (tralokinumab) from LEO Pharma, which was the second biologic to be listed in Korea, is gaining favor with many patients since its launch last year.

Adtralza, which has an IL-13 single-target mechanism that selectively targets only interleukin-13, was noted as a strong competitor to the existing Dupixent (which has an IL-4/13 dual-target mechanism).

In clinical trials, Adtralza achieved an EASI-75 score in 56% of patients at week 16, demonstrating its superior efficacy compared to placebo. It also showed a 38.9% achievement rate for an IGA score of 0/1 (almost clear of lesions).

Adtralza was listed for health insurance reimbursement in May 2024. In its first year, it has successfully established itself in the prescription lists of university hospitals, rapidly expanding its market share.

What are Adtralza's unique strengths, then? Professor Seo, who has prescribed various treatments in the clinical setting, highlighted Adtralza's excellent safety profile.

Professor Seo explained, "Dupixent generally has high satisfaction due to its excellent efficacy and low side effects, but its drawbacks include unexpected side effects like conjunctivitis and facial flushing," and added, "While Adtralza can also cause conjunctivitis, the incidence is lower than with Dupixent, and it shows an effect in improving symptoms in patients who experienced facial flushing with Dupixent."

As improvement of symptoms in exposed areas is directly related to a patient's quality of life, Adtralza could be a favorable option to reduce the disease burden for atopic dermatitis patients who experience social avoidance due to severe inflammation on their face or neck.

Patient A, who was present with Professor Seo, said, "After being treated with Adtralza, my symptoms improved noticeably over time. I took it for about half a year after the initial dose and felt a clear treatment effect."

Another strength is its cost-effectiveness. Regarding this, Professor Seo said, "Adtralza's drug price is lower than that of other biologics. It's about 60% of Dupixent's cost, which makes it a preferred option for patients with a significant financial burden."

Given the long-term nature of atopic dermatitis treatment, the cost of medication is a concern for both patients and medical professionals. In terms of cost-utility, Adtralza's superior accessibility is notable.

Limitations of inter-class switching…highlighted biomarker importance

With the increasing number of new treatment options, the project of creating an environment that benefits patients is gaining prominence.

This year, in response to requests from the field, the government partially relaxed reimbursement criteria to allow inter-class switching between biologics and JAK inhibitors. However, the lack of a provision for changing within the same class remains a point of regret.

Professor Seo said, "Atopic dermatitis is a complex disease with various contributing factors, so a more flexible insurance application is needed for treatment selection," and added, "The symptom patterns and patient responses can vary, so when one drug is insufficient, a path should be opened to allow switching to a different drug within the same class."

Lastly, Professor Seo emphasized the importance of biomarker development for the future of atopic dermatitis treatment.

He explained that although symptoms can now be suppressed for long periods with available therapies, personalized indicators are necessary to establish precision medicine.

Professor Seo added, "Atopic dermatitis is a difficult disease that requires long-term management, but with recent treatment innovations, it is becoming a manageable chronic disease." He concluded, "To implement precision medicine, we need personalized indicators for each patient, and when predictive treatment technologies are introduced in the future, we can take another step closer to curing atopic dermatitis."