Atopic dermatitis, a new drug that extinguishes inflammation is available in Italy
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On the one hand there is the genetic component, which predisposes the immune system to respond exaggeratedly to environmental stimuli. On the other hand, there is a dysregulation of the epidermal barrier, which is no longer able to perform its protective role adequately. Even the microbiota, i.e. the set of microorganisms that normally live on our skin, is altered, and this gives rise to a hypercolonization by a particular bacterium, the Staphylococcus aureus. Not only that: the alteration of the barrier and the immune response influence each other, making the situation worse. This is how atopic dermatitis, or atopic eczema, appears, a disease that is thought to affect between 2 and 3 million people: about 4% of adults. Of these, a fifth – over 35,000 – has the moderate-severe form: a disabling condition that heavily affects quality of life. Research in this field of medicine has made great progress in the last decade, and new hope for these patients now comes from a new oral drug recently approved by Aifa (Italian Medicines Agency). Let’s talk about abrocitinib, available for adults with severe atopic dermatitis who are candidates for systemic therapy.
Atopic dermatitis, how to keep the disease under control
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Atopic dermatitis: who affects and how
Until a few years ago, atopic dermatitis was considered a pathology of the pediatric age, but today we know that this is not the case. “It typically occurs in the first months of life, but can continue into adolescence and adulthood, or can arise ex novo in adults and even after the age of 65 – he explains Joseph Monfrecola, President of SIDeMaST – Italian Society of Dermatology and Sexually Transmitted Diseases – In fact, it affects about 15-20% of children under the age of 5, 7-10% of school-age children and 4-8% of adolescents. During growth, the mild forms tend to disappear, but there are cases in which this chronic inflammatory skin disease can last for life, with alternating phases of remission and exacerbations.
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Recognizing it is simple in children, while it may not be in adults, which is why the diagnosis often comes late. “It manifests itself – continues the expert – with very extensive redness, accompanied by intense and persistent itching and/or burning. Initially typical vesicles are formed which tend to dry out and become scaly. The whole picture is accompanied by a marked dryness of the skin”. The affected areas of the body are also typical and, unfortunately, visible: face, neck, hands and joints (eg at the elbows and knees, bilateral and symmetrical). Precisely because of this visibility and the strong itching, which often worsens at night causing insomnia, the disease has a heavy impact on the quality of life of patients and their families”. For a person with atopic dermatitis, even very normal actions, such as swimming in the sea or running, can exacerbate the problem.
How the new drug works
Abrocitinib belongs to the class of JAK inhibitors and works by blocking a protein (Janus kinase) which is at the base of the cascade of inflammatory signals that characterize atopic dermatitis. “It is a specific anti-inflammatory for this skin disease, which works by blocking both the inflammatory mediators and the itch mediators – he explains Giampiero Girolomoni, UOC Director of Dermatology and Venereal Diseases of the Verona Hospital – The mechanism of action is quite rapid and within a few days patients experience an improvement in symptoms. Abrocitinib should be administered to selected and monitored young/adult patients (from 18 years of age, ed.) affected by a more serious disease”. Abrocitinib is subject to limited medical prescription, to be renewed each time, and can be sold to the public on prescription from hospitals or dermatologist specialists.
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Six studies were conducted to evaluate the efficacy and safety of the drug, rigorous and on large populations, controlled and randomized, against placebo or against other active reference drugs. The results demonstrated the superiority of abrocitinib in early resolution of signs and symptoms and excellent tolerability. “The drug – continues Girolomoni – can be taken for as long as needed, it can be interrupted and restarted as needed. Therapy is started with a slightly higher dose and gradually the dosage is reduced according to the patient’s response, until a maintenance dose is reached”.
Fighting stigma
“Compared to 20 or 30 years ago, the situation for patients has improved: trained dermatologists and dermatology centers are present throughout the country and many more therapeutic aids are available – he says Mario Picozza, President of ANDeA – National Association of Atopic Dermatitis – But there is still a lot to do. Living with a disease like atopic dermatitis is a constant battle and challenge”. It is in fact a disease that can be felt and seen. “The psychological implications are important, also because the phenomena of social isolation and bullying are frequent. For this reason, as an association, we have drawn up a programmatic manifesto with the 10 points on which we ask the institutions to intervene promptly. We do this – he concludes – by participating, where possible, in the decision-making tables, and by maintaining a constant dialogue with the political decision-makers”.
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