EMERGING TARGETED THERAPIES FOR ATOPIC DERMATITIS IN THE SOUTH AFRICAN CONTEXT

Atopic dermatitis (AD) is a potentially debilitating condition, due to its negative effects on quality of life. Traditional treatments should be initiated in AD patients primarily. Unfortunately, current algorithms fail to offer reliable, targeted, safe and acceptable options to all AD patients. An improved understanding of AD pathogenesis and the increasingly targeted drugs the pharmaceutical industry is able to design, have resulted in a multitude of new investigational therapies for AD. Several novel therapeutic targets are being exploited. Only two agents, out of more than 70 in the pipeline, are currently relevant in the South African context. The first is dupilumab, a subcutaneously administered biologic which blocks IL-4 and IL-13, relevant to adaptive immune-system dysfunction in AD. Dupilumab is registered in South Africa and is currently being used in adult AD patients with moderate-to-severe disease, who do not respond to standard therapies. Dupilumab has demonstrated good efficacy and safety in both clinical and real-world studies. It is a financially costly treatment option. The second agent is upadicitinib, a JAK inhibitor currently undergoing the registration process. Hopefully, South African patients with AD will be able to benefit from the range of novel therapeutic strategies in the near future.