Newer Nonsteroidal Topical Treatments for Atopic Dermatitis: JAK Inhibitors and AhR Agonists
A panelist discusses how the ADORING trial for tapinarof demonstrated good efficacy and safety, but emphasizes that treatment choices for atopic dermatitis depend on patient needs, preferences, and the specific characteristics of their condition, with factors like speed of action, safety, and adherence playing key roles in decision-making.
The speaker reviews the ADORING trial for tapinarof, a topical treatment that modulates the aryl hydrocarbon receptor. Tapinarof demonstrated good efficacy across multiple end points, with the trial running up to week 8. Adverse effects mainly included irritation, contact dermatitis, or folliculitis (an acne-like condition). Overall, tapinarof showed a clean safety profile, with no boxed warnings. Despite these positive results, the speaker emphasizes that choosing between these treatments isn’t straightforward—there’s no one-size-fits-all option. Each treatment has its benefits, and the decision often comes down to patient needs, preferences, and the specific characteristics of their condition.
When comparing the different treatments, the speaker notes that speed of action would make ruxolitinib the fastest, but it also comes with boxed warnings and potential systemic adverse effects, which would make it the least preferable option in terms of safety. Conversely, crisaborole, roflumilast, and tapinarof all have safer profiles, no boxed warnings, and are more likely to be well-tolerated by patients. Because of this, they’re considered viable first-line options, as they balance effectiveness and safety. The speaker points out that patient preferences matter—most would prefer treatments that are less frequent, more elegant, and cause fewer irritations, especially in terms of burning and stinging sensations.
In making these treatment choices, patient adherence is crucial. The speaker discusses several strategies to improve adherence to topical treatments for atopic dermatitis, such as providing education, simplifying regimens, offering visual or written instructions, and maintaining regular follow-up. The survey results reflect that clinicians use a mix of these strategies. Education is key, but simplifying the regimen is also important for improving adherence and ensuring that patients stay committed to their treatment plan. Despite the availability of new systemic therapies, topicals remain a favored option because many patients prefer to avoid the risks associated with systemic treatments like injections or oral medications.
