"Precision medicines accelerate for treating atopic dermatitis"

Expanded biologics…changing the treatment methods amid an increase in patients with severe symptoms

Hurdles remain, such as limited switching therapies…"we must prepare for the era of targeted therapies"

Korea's treatment landscape for atopic dermatitis is facing a clear turning point. For the past 10 years, treatment strategies have centered on moisturizers, topical therapies, and immunosuppressants, which have remained the standard of care. The rapid introduction of new drugs, such as biologics and JAK inhibitors, is fundamentally changing the management of moderate-to-severe patients.

Professor Yang-Won Lee of the Department of Dermatology at Konkuk University Medical Center

Professor Yang-Won Lee of the Department of Dermatology at Konkuk University Medical Center, recently appointed as the President of the Korean Atopic Dermatitis Association, emphasized, "We have entered an era where the paradigm of atopic treatment is shifting," adding, "Insurance, policy, and clinical applications must be adjusted by reflecting the changes in patient groups and waves of new drug introductions."

The patient population for atopic dermatitis in Korea has changed significantly compared to the past. The prevalence has increased, and in particular, the proportion of adult atopic patients has expanded greatly, making a realignment of treatment strategies inevitable. Adult patients face long disease courses and a high proportion of chronic cases, creating a need for long-term treatment options that satisfy both safety and efficacy.

Related to this, the successive launches of biologics have provided a new alternative. Following the introduction of 'Dupixent (dupilumab, an IL-4/IL-13 inhibitor)' as the first interleukin agent in 2018, various biologics, including LEO Pharma's 'Adtralza (tralokinumab, an IL-13 inhibitor)', have emerged, expanding treatment options incomparably compared to the past.

With the addition of new drugs that are Janus kinase (JAK) inhibitors, the field of systemic treatment for moderate-to-severe patients has effectively entered a new phase.

However, despite the expanded treatment options, the common consensus in the field is that patient accessibility remains limited.

Professor Lee identified the 'restriction on switching therapies' as an area for improvement. While switching between biologics and JAK inhibitors has been permitted under certain conditions, switching within the same class remains prohibited, which is pointed out as narrowing the range of choices for patients.

Professor Lee expressed his concerns, stating, "Given the characteristics of atopic dermatitis patients who have complex pathophysiology, there seem to be many constraints on tailored treatment. This is an area that requires improvement."

Q. How do you feel about starting your term as the new President, and what is your opinion?

I have been active in the Korean Atopic Dermatitis Association for a long time. In particular, I participated from the very beginning in the process of creating a diagnostic code for severe atopic dermatitis in Korea, as none had existed previously. I also remember making my best efforts to ensure that severe atopic dermatitis could be covered under the 'Special Case Medical Expense Coverage System' system.

It feels like those events were just yesterday, and I am honored to be serving as President. Iplant to improve the rights and interests of patients with atopic dermatitis, the treatments they desire, and research into the disease.

Q. What are the primary goals or tasks that the Association will focus on during this term?

There are largely two main goals. The first is improving the rights and interests of patients with atopic dermatitis. Recently, many new atopic dermatitis drugs, such as biologics and JAK inhibitors, have been launched. However, due to high costs, many patients suffering from the disease are unable to receive treatment with these new drugs.

The Association will make every effort to ensure that health insurance and the 'Special Case Medical Expense Coverage System' system are applied to new drugs as quickly as possible.

The other goal is to promote research on atopic dermatitis. As the Korean Atopic Dermatitis Association is an academic organization, I intend to fulfill my responsibilities, including supporting researchers dedicated to identifying the causes of atopy and developing treatments, and conducting collaborative research.

Q. How do you think the patient population and disease patterns of atopic dermatitis in Korea have changed compared to the past? How do you think these changes have influenced the treatment paradigm?

The first change is that the prevalence has increased. This is partly due to more patients proactively visiting dermatology clinics as the medical environment has developed, but environmental changes driven by industrialization and other factors also play a role.

Another point is the increase in the number of adult patients with atopic dermatitis. As prevalence has increased and adult patients have become more numerous, the treatment paradigm has required new drugs that can ensure efficacy and safety for long-term treatment. In this context, the recently launched new drugs are playing a significant role.

Atopic dermatitis can be divided into mild, moderate, and severe stages. Mild patients are treated proactively with moisturizers and topical treatments. For moderate-to-severe cases, topical treatments and systemic treatments are used together.

Recently, new drugs such as biologics and JAK inhibitors have emerged, providing significant therapeutic benefit.

Q. While treating moderate-to-severe atopic dermatitis patients, what are the limitations of existing treatment strategies. What are unresolved unmet needs?

The biggest concern is the safety of existing conventional treatments.

In many cases, moderate-to-severe patients become chronic and require long-term treatment. However, there are safety concerns regarding the long-term use of conventional therapies such as existing immunomodulators.

Most of these issues are being addressed by new drugs such as biologics and JAK inhibitors. However, while the side effects of these new drugs are not severe, it seems necessary to be well-informed about the specific side effects of each drug to select the appropriate medication.

Currently, many atopic dermatitis treatments are being developed, and clinical trials are underway. The main direction is the development of targeted therapies that can secure higher safety and efficacy. 

In my opinion, the treatment of atopic dermatitis will evolve toward reducing side effects and increasing therapeutic effects through the development of targeted therapies that precisely target its pathophysiology.

Q. How can IL-13 single-target drugs change patient management?

Atopic dermatitis is a complex disease involving multiple immune pathways, but at its core, IL-13 plays a critical role in inflammation and skin barrier dysfunction.

Single-target IL-13 therapy, such as Adtralza, specialized for the pathophysiology, has the advantage of precisely regulating the core inflammatory pathway while minimizing unnecessary immunosuppression. 

In particular, with Adtralza, the physician can adjust the administration cycle after 16 weeks of treatment, providing advantages in terms of patient convenience and economic factors.

Q. Is there anything that needs to be improved in terms of treatment accessibility, insurance policy, or education?

I would like to speak about the issue of switching therapies. Since December 2024, switching between biologics and JAK inhibitors has been permitted under certain conditions, expanding the range of treatment options.

However, switching between a biologic and another biologic, or between JAK inhibitors, is still not allowed, and I hope this part will be improved. Regrettably, this seems to limit the tailored treatment of patients with atopic dermatitis who have complex pathophysiologies.

Q. Do you have any hope or advice you would like to send to patients and families suffering from atopic dermatitis?

Many patients and guardians still have much distrust, believing that atopic dermatitis treatments are toxic or that only corticosteroids are used.

With the recent development and launch of new drugs such as biologics and JAK inhibitors, the paradigm of atopic dermatitis treatment has changed and advanced. That progress is continuing today.

I hope that patients suffering from atopic dermatitis do not hesitate due to negative experiences from the past and instead visit a nearby dermatologist to receive proactive treatment.