番茄社区

In this exclusive 番茄社区 video, Peter Lio, MD, of Northwestern University Feinberg School of Medicine in Chicago, talks about how excited he is to have new and upcoming treatments for atopic dermatitis patients, and the differences in the mechanism of action between tralokinumab (Adbry) and dupilumab (Dupixent).

Following is a transcript of his remarks:

We were like little puppy dogs looking through the glass, saying when's it going to be our turn for atopic dermatitis? Psoriasis has so many great new treatments -- each one kind of better than the last, all these new ideas. And we finally got our first foray into biologics in 2017, and that's been great, because we finally have some options for [atopic dermatitis] patients -- but having only one.

And now we have a second one that came out a little more recently, but they're both the same pathway.

So to me, the thing I'm most excited about is getting some new pathways. We have an IL [interleukin]-31 inhibitor that's being worked on. I'm really interested, in that there are these OX40 ones that are being developed. There are other ones that we're just hearing murmurings about.

So I think we're starting to see there are a number of ways to hit these pathways, all with biologics, which I think in general as a class tend to be pretty safe and pretty targeted, which is really nice, but with different mechanisms of action.

So I just can't wait to have some choices. We're going to have an artist's palette and we'll be able to say, this one might be a good fit for this patient and this one might be a better fit for that patient. I can't wait to have that kind of flexibility.

I think that the truth is, if you didn't tell me, if we did a blinded clinical-size study without hundreds of patients, but maybe just the couple dozen patients that we have at any given time following up, I don't know if I could reliably differentiate, because we know that dupilumab and tralokinumab have similar mechanisms of action both on that same pathway.

Of course, dupilumab with IL-4 and IL-13, [tralokinumab] directly bind to IL-13, but are practically clinically very similar. And even the safety profile and side effects are quite comparable. When it was early on in development, we thought, oh, maybe this conjunctivitis issue that we're seeing with dupilumab, maybe this won't follow the other ones because what if it had to just do with IL-4?

But it doesn't seem to bear out. I still have a few patients who have developed some conjunctivitis with [tralokinumab], so they're pretty similar to me now. That's my clinical experience. But I will say they are a little bit different too, because I've had some patients who had an issue with dupilumab and then switched over and actually didn't have that same issue.

So again, I love having another option because I'll say, listen, it's pretty similar, but it's not the same. It really is a different molecule and it's targeting a slightly different aspect of this pathway. And so far in my hands, it's actually been pretty good. Although I will say it's been relegated a little bit to the second line, in part because dupilumab has a number of other indications.

And for me, most importantly, it has the age indications all the way down to 6 months of age, which is really powerful because about half my practice is pediatric.

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