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An Update on Drugs in Dermatology 2020 – 2021 Charles W. Lynde, MD, FRCPC, DABD Medical Director, The Lynde Institute for Dermatology & Lynderm Research Inc. Associate Professor, University of Toronto, Department of Medicine Dr. Charles W. Lynde has been a speaker, consultant and/or private investigator for: AbbVie, Allergan, Amgen, Aralez, Arcutis, Bausch Health, Bayer, Boehringer Ingelheim, Celgene, Cipher, Dermavant, Eli Lilly, Galderma, Genentech, Glenmark, GSK, Innovaderm, Janssen, Kyowa, L’Oreal, LeoPharma, Merck, Medexus, Mylan, Novartis, Pediapharm, Pfizer, Procter and Gamble, Roche, Sandoz, Sanofi Adventis, Sanofi Genzyme, Stiefel, TEVA, Valeant. Objectives 1.To be familiar with the key dermatological therapeutics of 2020 and what’s in the pipeline 2.To translate this information into changing dermatologic clinical practice Disrupter of 2020: COVID-19 COVID-19 has changed the way we practice medicine, how clinical trials operate and our personal lives Overview 1.Vaccines 8. Skin Cancer 2.Atopic Dermatitis 9. Vitiligo 3.Psoriasis 10. Alopecia 4.Palmoplantar Pustulosis 11. Anesthetic 5.Hidradenitis Suppurativa 12. Urticaria 6.Hand Dermatitis 7.Acne Vaccines Vaccines for COVID-19 As of November 2nd 2020 As of November 2nd 2020 there were there are 254 Active, Upcoming or 1,989 Active, Upcoming or Recruiting Trials Recruiting Trials and 273 Total Trials listed under listed under Vaccines COVID-19 on clinicaltrials.gov on clinicaltrials.gov 12.8% of all active, upcoming or recruiting vaccine trials are for COVID-19 Atopic Dermatitis Atopic Dermatitis As of November 2019 there As of October 30, 2020 there were are 855 trials 961 trials listed under listed under Atopic Dermatitis Atopic Dermatitis on clinicaltrials.gov on clinicaltrials.gov Atopic Dermatitis •New biologics •New small molecules •New topicals Pathogenesis Guttman-Yassky, Emma, et al. “New Era of Biologic Therapeutics in Atopic Dermatitis.” Expert Opinion on Biological Therapy, vol. 13, no. 4, 2013, pp. 549–561., doi:10.1517/14712598.2013.758708. Atopic Dermatitis Marked ….. ? the Barrier most Interpla Defect y important Microbio Immune me Defects Moisturizers • May be sufficient for mild disease • Should be applied liberally and often • Choice depends on individual preference • Should be effective, free of potential sensitizers, inexpensive TikTok Famous Biologics for Atopic Dermatitis • Dupilumab • September 2019: NOC Health Canada for > 12 years • May 2020: FDA Approval for 6-11 years • ANB020 • GBR 830-204 • KHK4083 • Tralokinumab • Lebrikizumab • Nemolizumab • Tezepelumab Dupilumab Phase 3 Trial: (LIBERTY AD PEDS) ≥ 6 to < 12 y/o IGA (0,1) at Week 161 EASI-75 at Week 161 100% †P=0.0004 100% ‡P<0.0001 ‡P<0.0001 80% 80% 67% 70% 60% 60% 40% 40% 33% 30% 27% Percentage of Patients Percentage of Patients 20% 20% 11% 0% 0% Placebo Dupilumab Dupilumab Placebo Dupilumab Dupilumab 100/200 mg 300 mg 100/200 mg 300 mg q2w q4w q2w q4w These data represent interim results from the trial. The efficacy and safety of dupilumab in children below the age of 12 have not currently been reviewed by a regulatory authority. EASI-75, improvement of ≥75% on Eczema Area and Severity Index score; IGA, Investigator’s Global Assessment; q2w, every 2 weeks; q4w, every 4 weeks. 1. Sanofi. https://www.sanofi.com/en/media-room/press-releases/2019/2019-08-06-07-05-00. Accessed August 6, 2019. GZCA.DUP.20.05.0158 Dupilumab Other Investigations • Severe Chronic Hepatic • Safety in Pregnancy Pruritus • Eosinophilic Esophagitis • Rhinosinunitis in Sleep Apnea • Localized Scleroderma Patients • Asthma • Severe Chronic Hand Eczema • Bullous Pemphigoid • Aspirin Excerbated Respiratory Disease • Prurigo Nodularis • Peanut Allergy • Atopic keratoconjunctivits ANB020 / Etokimab (Anaptysbio) • Indication: Moderate-to-Severe AD • MoA: IL-33 Inhibitor • Active: • Phase 2: A Study Investigating the Efficacy, Safety, and PK Profile of ANB020 Administered to Adult Subjects With Moderate-to-Severe AD (ATLAS) • Other indications being investigated: Eosinophilic Asthma, Peanut Allergy, Chronic Rhinosinusitis ClinicalTrials.gov GBR 830 / GBR 830-204 (Glenmark) • Indication: Atopic Dermatitis • MoA: IgG1 antibody specific for OX40 (CD134) • Active: • Phase 2b: Treatment of Adult Subjects • Administration: Subcutaneous injection • Other indications being investigated: None ClinicalTrials.gov KHK4083 (Kyowa) • Indication: Atopic Dermatitis • MoA: Anti OX40 Monoclonal Antibody • Active: • Phase 2: Treatment of Adult Subjects • Administration: Subcutaneous injection • Other indications being investigated: Ulcerative Colitis ClinicalTrials.gov Tralokinumab (LEOPharma) • Indication: Atopic Dermatitis • Expected Launch: US (FDA) ? Q2 2021 • MoA: IL-13 Inhibitor • Currently Recruiting / Upcoming: • Phase 2: Skin Barrier Function • Phase 3: In Combination with Topical Corticosetoids • Phase 3: Long Term Extension • Administration: subcutaneous injection • Other indications being investigated: alopecia areata, ulcerative colitis, asthma, pulmonary fibrosis COMING SOON ClinicalTrials.gov Lebrikizumab / DRM 06 (Dermira) • Indication: Atopic Dermatitis • MoA: IL-13 Inhibitor • Currently Recruiting: • Phase 3: Long-term Safety and Efficacy • Phase 3: Efficacy and Safety in Adults • Phase 3: Safety and Efficacy of in Adolescents • Phase 3: In Combination with Topical Corticosteroid • Administration: subcutaneous injection loading dose, followed by Q2W or Q4W • Other indications being investigated: Asthma, COPD, Idiopathic Pulmonary Fibrosis ClinicalTrials.gov Nemolizumab / CD14152 • Indication: Atopic Dermatitis • MoA: IL-31 Inhibitor • Currently Recruiting: • Phase 3: Long-term Safety and Efficacy • Phase 3: Efficacy and Safety in Adults • Phase 3: Safety and Efficacy of in Adolescents and Adults • Administration: subcutaneous injection • Other indications being investigated: prurigo nodularis ClinicalTrials.gov Tezepelumab / Amgen 20170755 (AMGEN) • Indication: Atopic Dermatitis • MoA: TSLP (Thymic Stromal Lymphopoietin) Inhibitor • STOPPED JULY 2020 – DID NOT MEET PRIMARY ENDPOINTS • Phase 2b: A Dose Ranging Placebo-Controlled Double-Blind Study to Evaluate the Safety and Efficacy • Administration: Subcutaneous injection with a treatment period of 52 weeks • Other indications being investigated: Severe Asthma, Asthma, COPD, Bronchial Disease, Respiratory Tract Diseases, and Respiratory Hypersensitivity, Chronic Spontaneous Urticaria ClinicalTrials.gov In 2018 we met JA(C)K (Lynde) Last year JAK was older and wiser This year JAK is in JK… he has matured Small Molecules • Abrocitinib – JAK-1 Inhibitor • Baricitinib – Selective JAK-1 Inhibitor • Brepocitinib – TYK2/JAK1 • LEO LP0190 – H4 Inhibitor • Upadacitinib – Selective JAK-1 Inhibitor • ZPL389 – H4 Inhibitor PF-04965842 / Abrocitinib (Pfizer) • Indication: Moderate-to-Severe AD • MoA: JAK-1 Inhibitor • Recruiting / Active: • Phase 3: Compared With Dupilumab in Adults With Moderate to Severe Atopic Dermatitis on Background Topical Therapy • Phase 3: Without Topical Medications in Subjects Aged 12 Years and Older • Other indications being investigated: Hepatic Impairment, Psoriasis • Launch: ? Q2 2021 “Search of: PF-04965842 - List Results.” Search of: PF-04965842 - List Results - ClinicalTrials.gov, clinicaltrials.gov/ct2/results?cond=&term=PF-04965842&cntry=&state=&city=&dist=. Non-head-to-head comparison of various novel treatment efficacy for moderate to severe AD EASI 75 (Week 12*/16) PBO UPA 7.5mg UPA 15mg UPA 30mg Column3 UPA 7.5mg2 UPA 15mg3 UPA 30mg4 Column1 PBO4 Abro 100mg Abro 200mg Column15 PF5842 100mg2 PF5842 200mg23 Column12 PBO2 SOLO 1 Dupi Q2W PBO3 SOLO 2 Dupi Q2W Column4 SOLO 1 Dupi Q2W2 SOLO 2 Dupi Q2W2 Column2 PBO42 Bari 2mg Bari 4mg Column5 Bari 2mg6 Bari 4mg7 100% MONOTHERAPY STUDY MONOTHERAPY STUDY MONOTHERAPY STUDIES COMBO STUDY WITH Phase 2 Phase 3 Phase 2 VARIABLE TCS USE IN PBO & BARI GROUPS Phase 2 75% 50% 25% 0% RAW DATA PLACEBO ADJ RAW DATA PLACEBO ADJ RAW DATA PLACEBO ADJ RAW DATA PLACEBO ADJ RINVOQ ABROCITINIB* DUPILUMAB BARICITINIB For Reference Only: Not From Head to Head Trials. Dupilumab Phase 3 vs Upadacitinib Phase 2 vs Baricitinib Phase 2 vs Abrocitinib Phase 2 Baricitinib / LY3009104 (Eli Lilly) • Indication: Moderate-to-Severe AD • Administration: Oral • MoA: JAK1/2 Inhibitor • Recruiting / Active: • Phase 3: Children and Adolescents With Atopic Dermatitis • Phase 3: With Topical Corticosteroids in Adults That Are Not Controlled With Cyclosporine or for Those Who Cannot Take Oral Cyclosporine • Phase 3: A Study of Long-term Baricitinib (LY3009104) Therapy in Atopic Dermatitis (BREEZE-AD3) • Other indications being investigated: RA, Giant Cell Areritis, Liver Disease, AA • Launch: ? Q4 2020 / 2021 ClinicalTrials.gov Brepocitinib / PF-06700841 (Pfizer) • Indication: Moderate-to-Severe AD • Administration: Oral • MoA: TKY2/JAK1 • Completed: • Phase 2: Dose Ranging Study to Assess Efficacy, Safety, Tolerability and Pharmacokinetics of PF-06700841 Topical Cream in Participants With Mild or Moderate Atopic Dermatitis • Other indications being investigated: SLE, Crohn’s, PsO, PsA, UC, AA ClinicalTrials.gov Upadacitinib / M16-045 (Abbvie) • Indication: Moderate-to-Severe AD • Administration: Oral dose with a treatment period of 16 weeks and a blinded extension period up to 3 years • MoA: JAK-1 Selective Inhibitor • Recruiting / Active: • Phase 3: Open-Label Extension Study • Phase 3: Evaluation of Upadacitinib in Adolescent and Adult Patients • Phase 3: In Combination With Topical Corticosteroids in Adolescent and Adult Participants