Healio highlights top dermatology news of the year, decade
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As 2019 draws to a close, Healio reflects on the top news in dermatology from not only the past year, but the past 10 years, as we welcome a new decade of discoveries and practice-changing approvals.
We asked Healio Dermatology Peer Perspective Board Members Peter Lio, MD, of Northwestern University Feinberg School of Medicine, and Anthony Fernandez, MD, PhD of the Cleveland Clinic, for their thoughts on the most important news, and here’s what they had to say. – by Stacey L. Adams
What are the most exciting advancements in the field over the past 10 years? What were the biggest lessons?
Lio: We have seen a tremendous revolution in the care of psoriasis, with numerous options never before available. We have gone from several agents to increasingly safe and effective systemic therapies that are practically tripping over each other to show superiority. Despite their high costs, I would argue that both patients and doctors are winners here, with new options to get better control than ever before and new guidelines that have set a very high “treat to target” bar.
Fernandez: The development and approval of immunotherapies for advanced melanoma and other advanced malignancies, such as PD-1 inhibitors and CTLA-4 inhibitors, in my mind represents the biggest advancement in the past decade.
The lessons learned are confirmation concerning how powerful and important of a weapon our own immune system is in fighting and destroying malignant cells.
These medications are now infiltrating into other malignancies: advanced squamous cell carcinoma, Merkel cell carcinoma. That is such a huge story.
The past decade, in general, has seen the dawn of targeted therapy. At the beginning of the decade, even for psoriasis we had just a few TNF inhibitors and ustekinumab (Stelara, Janssen) had just been FDA approved, but efalizumab had just been taken off the market. Now look at all of the targeted therapies we have for psoriasis alone nowadays — the IL-17 inhibitors, the IL-23 inhibitors, Otezla (apremilast, Celgene), and we’re not done yet. That same targeted approach of monoclonal antibodies and small molecule inhibitors are now used or being pursued in hidradenitis suppurativa and others, including mycosis fungoides (CCR-4) and atopic dermatitis (IL-4, IL-13 inhibitors). All the molecular advancements in the 1980s and 1990s have finally come to fruition to provide useful treatments in the clinic. This past decade has been the decade where targeted therapies and the generation of monoclonal antibody therapies have really become mainstream.
What news/FDA approval changed your practice in 2019?
Lio: The approval of dupilumab (Dupixent, Regeneron/Sanofi Genzyme) for 12- to 17-year-olds allowed for an important new therapy in a key group of patients with severely limited systemic options. More than anything this past year, this has been a boon for me and my patients.
Fernandez: The approval of dupilumab for adolescents was a big deal; that is a practice changer.
What are you most looking forward to in the next 5 years?
Lio: I am looking for more options to treat atopic dermatitis. While we finally have started the “decade of eczema” with the first new options in many years recently coming to market, it is my great hope that this is truly only the beginning. Each addition is welcome, as there is no “one size fits all” in atopic dermatitis, so we need new systemic agents (like the JAK inhibitors and other biologic agents), as well as new topical agents (such as the JAK inhibitors and totally new agents such as tapinarof).
Fernandez: The continued approval of additional targeted therapies for chronic inflammatory diseases. I think in the next 5 years we’re going to learn a tremendous amount about hidradenitis suppurativa, which is an area where we’re still in dire need of better therapies.
I think we’re also going to begin introducing additional treatment options for autoimmune diseases like lupus and dermatomyositis. I’m hoping that they are very welcome additions, compared to the traditional immunomodulatory medicines we now typically use.
For more information:
Anthony Fernandez, MD, is clinical assistant professor of clinical medicine at Cleveland Clinic Lerner College of Medicine and director of Medical Dermatology at the Cleveland Clinic.
Peter Lio, MD, is clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine.
Disclosures: Fernandez reports receiving research support from Corbus, Mallinckrodt, Novartis and Pfizer; and honorarium for consulting, advisory board participation and/or speaking from AbbVie, Mallinckrodt, Novartis and UCB. Lio reports receiving grants as an investigator and/or honoraria for lecturing, and/or consultant fees from AbbVie, AOBiome, Arbonne, Burt's Bees, Dermavant, Dermira, Eli Lilly, Exeltis, Franklin Bioscience/Altus Labs, IntraDerm, Johnson & Johnson, Kiniksa, La Roche Posay/L'Oreal, LEO Pharmaceuticals, Menlo Therapeutics, the National Eczema Association, Pfizer, Pierre-Fabre, Realm Therapeutics, Regeneron/Sanofi Genzyme, Theraplex, TopMD, UCB, Unilever and Verrica.