Emerging systemic therapies for atopic dermatitis: oral small molecules and targeted topical agents

Abstract

Background

Until recently, treatment of atopic dermatitis has been limited to topical corticosteroids, calcineurin inhibitors, phototherapy, and systemic immunomodulatory agents. With improved understanding of the pathogenesis underlying atopic dermatitis, targeted oral small molecules and topical agents are being developed.

Objective

Discuss efficacy and safety profiles of emerging oral small molecules and targeted topical agents in phase 2 and 3 clinical trials.

Methods

A systemic literature review was conducted to identify results of randomized, placebo-controlled trials of oral small molecules and topical Janus kinase inhibitors up to March 1 2020 for the treatment of atopic dermatitis.

Results

Three novel oral small molecules, abrocitinib, upadacitinib, and baricitinib, demonstrated improvement of clinical severity, pruritus, and quality of life with acceptable safety profiles. Apremilast, a phosphodiesterase inhibitor, was less efficacious with use limited by adverse effects. Two novel topical agents, ruxolitinib and delgocitinib, were effective and well-tolerated.

Conclusions

Targeted therapeutics including oral small molecules and topical agents show promise for the treatment of atopic dermatitis. The use of validated core measures is necessary for future trials in order to adequately compare agents and progress evidence-based medicine.

Keywords:

• Atopic dermatitis
• oral small molecules
• topical therapies
• treatment

Disclosure statement

Alan Fleischer is a consultant for Boehringer-Ingelheim, Dermavant, Incyte, Qurient, SCM Lifescience and Syneos. He is an investigator for Galderma, Menlo and Trevi. He has no other potential conflicts including Honoraria, Speakers bureau, Stock ownership or options, Expert testimony, Grants, Patents filed, received, pending, or in preparation, Royalties, or Donation of medical equipment.