Atopic Dermatitis, Dermatological Conditions CE/CME ACCREDITED Watch Time: 38 mins

touchTALKS Growing up with atopic dermatitis: Achieving sustained outcomes for moderate-to-severe disease

Dr Melinda Gooderham presents the latest data and future directions of systemic therapy for moderate-to-severe atopic dermatitis.

 
Video Chapters
Why is an accurate assessment of the burden of moderate-to-severe atopic dermatitis critical?

Dr Melinda Gooderham highlights how moderate-to-severe atopic dermatitis impacts the quality of life of patients and their families. She discusses how disease severity and burden can be assessed, and how this affects treatment decisions.

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Can systemic therapy achieve sustained control of signs, symptoms and quality of life in atopic dermatitis?

Dr Gooderham presents pivotal clinical trial data that demonstrate how effective systemic therapy can achieve sustained control of symptoms of atopic dermatitis and improve the quality of life of patients and their families.

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How may emerging systemic therapies change the management of moderate-to-severe atopic dermatitis?

Dr Melinda Gooderham dives into the latest data on emerging systemic therapies for atopic dermatitis and discusses their potential to change the treatment landscape.

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Overview & Learning Objectives
Overview

Watch Dr Melinda Gooderham as she discusses how moderate-to-severe atopic dermatitis impacts the quality of life of patients, and how current and emerging systemic therapies can lift the burden of disease.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of dermatologists, immunologists and allergists involved in the management of atopic dermatitis worldwide.

Disclosures

All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Dr Melinda Gooderham discloses: Advisory board or panel fees from AbbVie, Amgen, Arena Pharmaceuticals, Inc., Asana BioSciences, Bausch, Boehringer Ingelheim, Celgene, Eli Lilly, Galderma, Janssen, LEO Pharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi-Genzyme, Sun Pharmaceutical Industries Ltd. and UCB. Consultancy fees from AbbVie, Akros, Amgen, Bausch, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen, Kyowa Kirin, Novartis, Roche, Sanofi-Genzyme, Sun Pharmaceutical Industries Ltd. and UCB. Grant/research support from AbbVie, Akros, Amgen, Arcutis Biotherapeutics, Bausch, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus BioSciences, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Glenmark, Janssen, Kyowa Kirin, LEO Pharma, Medimmune, Merck & Co., Novartis, Pfizer, Regeneron Pharmaceuticals Inc., Roche, Sanofi-Genzyme, Sun Pharmaceutical Industries Ltd. and UCB.

Content reviewer

Ann Lin, DO, MS has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Kathy Day has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credit for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 30 November 2021. Date credits expire: 30 November 2022.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Recognize the burden of moderate-to-severe atopic dermatitis and the importance of assessments of disease severity
  • Recall the latest data on efficacy and safety of systemic therapies in the management of both paediatric and adult patients with moderate-to-severe atopic dermatitis
  • Describe the rationale for rapid and sustained control of atopic dermatitis and the impact of emerging systemic treatment options on the management of moderate-to-severe atopic dermatitis
Faculty & Disclosures
Dr Melinda Gooderham

SKiN Centre for Dermatology, Peterborough, Ontario, Canada.

Melinda Gooderham, MSc, MD, FRCPC, is a Dermatologist and Medical Director at the SKiN Centre for Dermatology, and an Investigator with Probity Medical Research in Peterborough, Ontario, Canada. read more

Dr Gooderham is an Assistant Professor at Queen’s University, and a Consultant Physician at the Peterborough Regional Health Centre. She is a fellow of the Royal College of Physicians and Surgeons of Canada.

Dr Gooderham has been the principal investigator for 170 clinical trials and she practices with a focus on inflammatory diseases of the skin. She also contributes to several peer-reviewed dermatology publications as an associate editor and reviewer, and has been an author of over 150 articles. 

Dr Melinda Gooderham discloses: Advisory board or panel fees from AbbVie, Amgen, Arena Pharmaceuticals, Inc., Asana BioSciences, Bausch, Boehringer Ingelheim, Celgene, Eli Lilly, Galderma, Janssen, LEO Pharma, Novartis, Pfizer, Regeneron Pharmaceuticals, Inc., Sanofi-Genzyme, Sun Pharmaceutical Industries Ltd. and UCB. Consultancy fees from AbbVie, Akros, Amgen, Bausch, Boehringer Ingelheim, Celgene, Eli Lilly, Janssen, Kyowa Kirin, Novartis, Roche, Sanofi-Genzyme, Sun Pharmaceutical Industries Ltd. and UCB. Grant/research support from AbbVie, Akros, Amgen, Arcutis Biotherapeutics, Bausch, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Coherus BioSciences, Dermira, Eli Lilly, Galderma, GlaxoSmithKline, Glenmark, Janssen, Kyowa Kirin, LEO Pharma, Medimmune, Merck & Co., Novartis, Pfizer, Regeneron Pharmaceuticals Inc., Roche, Sanofi-Genzyme, Sun Pharmaceutical Industries Ltd. and UCB.
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This Activity Is Funded By:

An independent medical education grant from Sanofi Genzyme and
Regeneron Pharmaceuticals.
This activity is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 30 November 2021. Date credits expire: 30 November 2023.

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
Which of the following statements about the impact of atopic dermatitis on quality of life is correct?
 Correct

Psychosocial comorbidities, including sleep difficulties, depression and anxiety, are common among adult patients with moderate-to-severe AD and were reported by 56.6%, 70.7% and 60.9%, respectively, in a survey of 1,017 patients in the USA.1

AD has an impact on mental health and quality of life also in children and their families.2  AD was found to be associated with higher odds of depression in adults (OR=2.08; 95% CI, 1.70–2.55) than in children (OR=1.31; 95% CI, 0.99–1.75); and parents of children with AD were overall more likely to have depression (OR=1.60; 95% CI, 1.01–2.53).2

Abbreviations
AD, atopic dermatitis; CI, confidence interval; OR, odds ratio.

References

  1. Kwatra SG, et al. Adv Ther. 2021;38:1627–37.
  2. Patel KR, et al. J Am Acad Dermatol. 2019;80:402–10.
Question 2/5
Which of the following statements about agents for systemic therapy for atopic dermatitis is correct?
 Correct

Dupilumab is an IL-4Rα antagonist administered by subcutaneous injection.1 It is approved by the FDA for the treatment of patients ≥6 years old with moderate-to-severe AD  whose disease is not controlled with topical therapies, and by the EMA for patients who are candidates for systemic therapy and are either ≥12 years old with moderate-to-severe AD, or 6–11 years old with severe AD.1,2

Long-term data from pivotal clinical trials and real-world evidence show that dupilumab provides significant improvement and disease control with a favourable safety profile, even when administered for >1 year.1–3

Cyclosporin A is licenced in many European countries and used off-label in the USA for the systemic treatment of AD.4,5 Continuous cyclosporin treatment is limited to a maximum of 2 years due to side effects such as nephrotoxicity and hypertension.4

Abbreviations
AD, atopic dermatitis; EMA, European Medicine Agency; FDA, US Food and Drug Administration; IL-4Rα, interleukin 4 receptor alpha.

References

  1. Dupilumab. Prescribing information. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/761055s035lbl.pdf.
  2. Dupilumab. Summary of product characteristics. Available at:  www.ema.europa.eu/en/documents/product-information/dupixent-epar-product-information_en.pdf.
  3. Bagel J, et al. Presented at the European Academy of Dermatology and Venereology 30th congress 2021. Abstract #2007.
  4. Wollenberg A, et al. J Eur Acad Dermatology Venereol. 2018;32:850–78.
  5. Davari DR, et al. J Asthma Allergy. 2021;14:595–607.

All links accessed 18 October 2021.

Question 3/5
Your patient is an 11-year-old boy with severe atopic dermatitis who is initiating systemic treatment with dupilumab plus topical corticosteroids. Based on his weight of 35 kg, you prescribe a loading dose of dupilumab 400 mg, followed by 200 mg every 2 weeks. For which of the following side effects would you monitor him and how would you manage it?
 Correct

In the LIBERTY-AD-PEDS study, children 6–11 years old with severe atopic dermatitis not controlled with topical medications were randomized to receive TCS plus dupilumab at different doses and regimens based on their weight.1

The optimal dupilumab regimens for efficacy and safety were found to be 200 mg Q2W for patients weighing ≥30 kg, and 300 mg Q4W for patients weighing 15–<30 kg.1

Based on these results, dupilumab was approved by the FDA for children ≥6 years old, with a regimen of 200 mg Q2W (loading dose of 400 mg) for children weighing 30–<60 kg.2 The EMA-approved regimen for children weighing 15–<60 kg is an initial 300 mg dose, a second 300 mg dose after 2 weeks, and then 300 mg Q4W.3 Neither the FDA nor the EMA recommend a regimen of 100 mg Q4W for any age or weight groups.2,3

In the LIBERTY-AD-PEDS study, injection site reactions and conjunctivitis were more common in children who received dupilumab plus TCS compared with placebo plus TCS.1 Standard ophthalmic treatment resulted in recovery from conjunctivitis in most patients.1

Abbreviations

EMA, European Medicine Agency; FDA, US Food and Drug Administration; TCS, topical corticosteroids; Q2W, once every 2 weeks; Q4W, once every 4 weeks.

References

  1. Paller AS, et al. J Am Acad Dermatol. 2020;83:1282–93.
  2. Dupilumab. Prescribing information. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/761055s035lbl.pdf.
  3. Dupilumab. Summary of product characteristics. Available at: www.ema.europa.eu/en/documents/product-information/dupixent-epar-product-information_en.pdf.

All links accessed 18 October 2021.

Question 4/5
Your patient is a 13-year-old girl with atopic dermatitis not controlled with topical treatment. She was offered systemic therapy with dupilumab before, but her and her family are reluctant to initiate therapy via subcutaneous injection. Assuming all options below were available and approved, which treatment would you prescribe?
 Correct

Abrocitinib is an oral JAK1 inhibitor which has been shown to be effective in the treatment of adults and adolescents (≥12 years old) with moderate-to-severe AD not controlled with topical medication.1,2

In the JADE-MONO-1 and -2 trials, the percentage of patients who achieved IGA=0/1 with 2 points reduction from baseline, or ≥75% EASI improvement from baseline, was significantly higher in the abrocitinib monotherapy groups (100 mg or 200 mg daily), compared with placebo.1,2 As of October 2021, abrocitinib is approved in the UK for the treatment of moderate-to-severe AD in patients ≥12 years old  who are candidates for systemic therapy.3

Tralokinumab, lebrikizumab and nemolizumab are all monoclonal antibodies which are delivered by subcutaneous injection.4

Abbreviations

AD, atopic dermatitis; EASI, Eczema Area and Severity Index; IGA, Investigator’s Global Assessment.

References

  1. Simpson EL, et al. Lancet. 2020;396:255–66.
  2. Silverberg JI, et al. JAMA Dermatology. 2020;156:863–73.
  3. UK Medicines and Healthcare products Regulatory Agency. Abrocitinib. Summary of product characteristics. 2021. Available at: www.medicines.org.uk/emc/product/12873/smpc#gref (accessed 18 October 2021).
  4. Puar N, et al. Ann Allergy Asthma Immunol. 2021;126:21–31.
Question 5/5
Which of the following side effects would you advise your patients to look out for when starting treatment with a systemic JAK inhibitor for atopic dermatitis?

JAK, Janus kinase.
 Correct

Common side effects reported for all three JAK inhibitors approved for systemic treatment of atopic dermatitis in the UK or Europe as of October 2021 (abrocitinib, upadacitinib and baricitinib) include nasopharyngitis and upper respiratory tract infections, as well as nausea and headache, but not conjunctivitis.1–3

Abbreviations

EMA, European Medicine Agency; JAK, Janus kinase; MHRA, UK Medicines and Healthcare products Regulatory Agency; SmPC, summary of product characteristics.

References

  1. MHRA. Abrocitinib. SmPC. 2021. Available at: www.medicines.org.uk/emc/product/12873/smpc#gref.
  2. EMA. Upadacitinib. SmPC. 2021. Available at: www.ema.europa.eu/en/documents/product-information/rinvoq-epar-product-information_en.pdf.
  3. EMA. Baricitinib. SmPC. 2020. Available at: www.ema.europa.eu/en/documents/product-information/olumiant-epar-product-information_en.pdf.

All links accessed 18 October 2021.

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