Evaluating the safety and efficacy of baricitinib for the treatment of moderate-to-severe atopic dermatitis.

INTRODUCTION: New biologic and small molecule therapeutics have emerged for the treatment of moderate-to-severe atopic dermatitis (AD), including oral Janus kinase (JAK) inhibitors such as baricitinib. While JAK inhibitors are commonly used to treat rheumatoid arthritis and inflammatory bowel disease, these agents are relatively new in the field of dermatology. AREAS COVERED: In this review, we outline the efficacy and safety data of phase III randomized controlled trials investigating the use of baricitinib for moderate-to-severe AD. A literature search was performed using PubMed.gov to identify articles relevant to the topic published before August 2023. EXPERT OPINION: Oral JAK inhibitors in AD management are highly efficacious, whether used alone, in conjunction with topical corticosteroids, or in patients who have failed other conventional systemic medications for AD. JAK inhibitors appear to be well tolerated in the AD patient population with fewer major safety risks than what has been seen in other patient populations. Assessing patient risk factors for cardiovascular, thromboembolic, and oncologic diseases is now an important part of the office visit for patients in whom you may consider using a JAK inhibitor.

New synthetic pharmacotherapeutic approaches to the treatment of moderate-to-severe plaque psoriasis in adults.

INTRODUCTION: Psoriasis is a chronic inflammatory and immune-mediated condition affecting 3.2% of the United States population. There are many options for psoriasis treatment including topicals, oral systemic agents, and biologics. A greater understanding of the pathophysiology of psoriasis has led to an increase in the therapeutic options for treatment. AREAS COVERED: In this review, we outline the novel synthetic agents for moderate-to-severe plaque psoriasis and discuss a strategy for implementing these agents in clinical practice. A literature search was performed using PubMed to identify articles relevant to the topic published before October 2022. EXPERT OPINION: Topicals are first-line for the treatment of moderate-to-severe plaque psoriasis, most commonly including topical steroids, vitamin D analogs, and topical calcineurin inhibitors. While new topical agents have favorable properties, they are not always effective and adherence to topical agents is poor. Biologics are safe and effective, but patients often prefer oral therapy as opposed to injectable medications. Additionally, anti-drug antibodies can reduce effectiveness of biologics over time. Oral medications are preferred, but we now have a high bar for efficacy and safety. Cost is also a barrier for many patients. Recent development of new synthetic treatment options is promising, and we recommend that providers consider these agents as they develop holistic and individualized treatment plans for their patients.

Treatment Adherence in Dermatology During the COVID-19 Pandemic: A Review.

The coronavirus disease 2019 (COVID-19) pandemic raised many challenges for dermatology. Safety is a principal concern for many patients, particularly those on medications that affect the immune system. Understanding how the pandemic affects patients' treatment adherence may be informative for counseling or other interventions to assure that treatment plans are not inappropriately interrupted, or for future pandemics. The purpose of this review was to investigate the extent to which the COVID-19 pandemic affected medication adherence in dermatology. A literature search of PubMed was performed using the search terms: adherence, compliance, dermatology, COVID-19, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and pandemic. Eleven primary research studies met the inclusion criteria and were included in the review. During the COVID-19 pandemic, non-adherence in dermatology patients was primarily linked to concern about the risk of COVID-19 infection with long-term use of immunomodulatory and immunosuppressive medications. In some cases, non-adherence was associated with feelings of depression, anxiety, or perceived stress. High adherence was attributed to regular and convenient communication between patients and dermatology providers through the effective use of telemedicine and electronic messaging. Frequent communication with providers to address patient concerns and provide continuity of care improved adherence. An integrated virtual approach to patient care facilitated this, particularly through the use of telemedicine. Implementation of routine virtual questionnaires was, to some extent, effective in replacing limited in-person patient-provider interactions during the pandemic. Finally, the added threat of the pandemic presented an additional mental health component to consider for patients, supporting the need for a multidisciplinary approach to patient care.