* is for reference only for medical professionals
to relieve itching, remove skin lesions, be safe and controllable, and AD patients can expect to be.
Shanghai First People's Hospital
Professor Wu Zhouwei
"Relieve itching and remove skin lesions as soon as possible are the two most urgent needs of AD patients in clinical treatment. How to quickly and well control symptoms and improve the quality of life of patients under the basic principles of reasonable and safe use of drugs is the goal that clinicians need to help patients achieve. The highly selective JAK1 inhibitor abuxitinib is a powerful weapon to achieve this goal."
As the "No. 1 disease" in dermatology, the diagnosis and treatment of atopic dermatitis (AD) has always been a "difficult" problem. AD can affect patients of all ages and bring about serious disease burden. Regarding its clinical diagnosis, Professor Wu Zhouwei of Shanghai First People's Hospital said that AD is a highly heterogeneous disease and requires standardized and practical standards to guide clinicians' diagnostic behavior.
"In fact, many AD diagnostic standards have been introduced internationally, among which the more classics are the Hanifin-Rajka standard and the Williams standard. There are as many as 27 items in Hanifin-Rajka standard, which are complex and inconvenient for clinical application. In contrast, the Williams standard is simpler and easier to implement, but its sensitivity in the diagnosis of adult AD patients has been reduced [1]. In recent years, Chinese scholars such as Professor Zhang Jianzhong and Yao Zhi, have been shown to be less sensitive. Professor Rong has continuously explored and optimized AD diagnostic standards and proposed the "Zhang's standard" [2] and "Yao's standard" [3-4] with Chinese characteristics, which are suitable for the diagnosis of adult/adolescent AD and infant/child AD patients respectively. The proposal and application of these two Chinese standards greatly improve the diagnosis rate of AD in clinical practice and provide a strong basis for subsequent treatment. "
Accurate diagnosis is the premise and basis for effective treatment. Like diagnosis, AD treatment is challenging due to the heterogeneity of the disease and population. How do we respond to changes in treatment concepts and needs in clinical practice, and the update of treatment methods and strategies?
takes patient needs as the starting point, pays attention to patient treatment experience, and improves patient satisfaction
At present, the concepts and models of medical services are changing from the traditional "disease-centered" to the advanced "patient-centered" and emphasizes the dominant position of patients in this process. Professor Wu Zhouwei pointed out that this concept and model are also applicable to the field of AD treatment. Patients’ individual needs are the main goal of clinical AD treatment. Clinicians should work towards this goal and actively solve their problems for patients.
control itching and clear skin lesions are two core issues in AD treatment and are also the most urgent treatment needs of patients. Repeated severe itching and dry and damaged skin throughout the body have seriously affected the normal life, study and work of many AD patients. Many patients have reported that the troubles of disease symptoms prevent them from sleeping all night, and the impact of skin lesions on their appearance makes them unconfident, feeling that their lives are like being shackled and falling into bad emotions of anxiety and depression... Professor Wu Zhouwei said that in order to better respond to patients' diverse, multi-level and individual needs, clinicians should communicate with patients fully and understand their needs, and at the same time help patients face up to the disease, so that they have a correct understanding and attitude towards the treatment and management of the disease, mobilize their subjective initiative, and actively participate in treatment decisions.
Professor Wu Zhouwei introduced that the internationally recognized AD treatment strategy is mainly "stage" hierarchical treatment, that is, under the premise of basic treatment, the corresponding treatment plan is selected according to the severity of the disease. "This is a very standardized, from light to severe step-up treatment strategy. However, the latest AD diagnosis and treatment guide for the 2022 European Society of Dermatology and Venereology (EADV) also proposes that it may be too arbitrary to determine the severity of the patient and whether to initiate systemic treatment based on the score. When to initiate systemic treatment, it should be more in line with the patient's personal wishes. " Therefore, in actual clinical practice, doctors adopt the most direct and effective treatment plan when the patient's specific condition and personal needs, based on the patient's specific condition and personal needs, and strive to control the disease in the short term and avoid the patient's loss of confidence due to repeated attempts.
A large part of the reason why we are confident in giving effective treatment to patients is that various advanced targeted therapy "weapons" have emerged in the systematic treatment of patients with moderate and severe AD. Whether it is the field of large-molecular biological agents or small-molecular targeted drugs, new breakthroughs are constantly being made. During this process, the treatment experience of AD patients has been significantly improved, and treatment satisfaction has also been effectively improved.
molecule is small, but it performs amazingly! Highly selective JAK1 inhibitors have been constantly refreshing records in research
Among various new AD therapeutic drugs, abuxitinib is an existence that cannot be ignored. As a breakthrough therapy for AD treatment, abuxitinib has attracted much attention in the clinical trial stage.
Abuxitinib is a highly selective JAK1 inhibitor, which is different from biological agents and first-generation JAK inhibitors. As a small molecule drug, abuxitinib is rapidly absorbed and peaked in the body, and quickly relieves itching within 24 hours after taking the drug. More importantly, it can effectively inhibit multiple AD-related cytokines by multiple targets, and its effects are more comprehensive than biologics targeting a single target or inflammatory pathway.
"Compared with non-selective JAK inhibitors, what is more prominent in abuxitinib is its good safety." Professor Wu Zhouwei explained the advantages of highly selective JAK1 inhibitors based on the mechanism of action. He pointed out that the safety of non-selective JAK inhibitors has always been controversial, and they have brought many safety hazards to the broad-spectrum inhibition of various JAK subtypes, which is very likely to inhibit other normal signaling and physiological processes in human cells. How to solve this problem? Different subtypes of JAK mediates different immune cytokine signaling pathways and biology activity [9-10], which can more accurately inhibit the pathways that promote AD generation and development and reduce interference to other normal pathways, and minimize negative impacts. Abuxitinib is produced in accordance with this idea.
"A variety of studies on abuxitinib have also confirmed its efficacy and safety." Based on its clinical data, Professor Wu Zhouwei talked about the role characteristics of abuxitinib. From the perspective of efficacy, abuxitinib treatment can achieve rapid itching control and skin lesions clearance. Two phase III studies of JADE MONO-1/2 showed that during the 12-week monotherapy of abuxitinib, the proportion of patients who achieved ≥75% of the area and severity index improvement of eczema (EASI-75) continued to increase. By week 12, the response rate of EASI-75 in the abuxitinib 200mg QD group was 60%, which was significantly higher than that of [8,11] in the placebo group. The onset speed of itching relief is even more amazing. The significant change in the peak itching digital score scale (PP-NRS) score was observed within 24 hours of medication. The PP-NRS4 response rate (defined as the proportion of patients with PP-NRS score improvement of ≥4 points) in the 200mg QD group at week 2 was close to 50% [8]. "The common adverse reactions of abuxitinib in clinical practice include nausea, headache, vomiting, etc. [12]. Generally speaking, these mild adverse reactions are easier to deal with. For example, platelet reduction is mostly transient, and it is rare to stop the drug due to adverse reactions in clinical practice."
"The patients have more smiles and are in a cheerful mood, and I am very happy for them."
abuxitinib has been approved in China to treat adult patients with moderate to severe AD for nearly half a year. During this period, Professor Wu Zhouwei applied it to the treatment of many patients with different types of AD. Talking about the experience of medication, Professor Wu Zhouwei said that these patients are often in serious condition when they are admitted to the hospital, and their daily lives are severely troubled by the disease. Patients generally show anxiety or depression and have high expectations for the onset of treatment. "After the treatment of abuxitinib, the patients all said that the clinical efficacy was very significant. Many patients told me in surprise that they felt the itching relieved on the day of the medication, and some patients even said that the itching was relieved after ten minutes of each medication. The effect of the rash receding may be relatively slow, but it also improved very significantly."
Professor Wu Zhouwei shared with us the treatment effect of abuxitinib in a young AD patient.The young man originally planned to join the army, but failed to enlist because he failed the physical examination. He once thought that his life was destroyed by illness and felt very uncomfortable. After detailed communication with the patient and his family, it was found that the patient had a strong desire to improve severe itching and hoped to remove the skin lesions as soon as possible and resume normal life. To this end, Professor Wu Zhouwei chose abuxitinib to treat the patient. During the follow-up visit, the patient complained that he felt itchy on the day of taking the medication. After 3 months of treatment, the skin lesions had been basically cleared. Professor Wu Zhouwei sighed: "When the patient came to the follow-up visit, he no longer looked as frowning as before, but smiled cheerfully. When talking, he could feel that his emotions were much more stable. I am really happy for him and felt that he was very accomplished!"
attached to the real clinical case information provided by Professor Wu Zhouwei*:
Figure 1: Improvement of the patient's skin lesions (above, upper limbs; lower limbs)
In addition, Professor Wu Zhouwei also mentioned the medication experience in treating elderly patients. In addition to the speed of onset and intensity of efficacy, what elderly patients care about most is the issue of the safety of medication. Professor Wu Zhouwei told us that elderly patients are very cautious about the use of drugs and often read them repeatedly with the instructions for medicine and discuss them with him. "After sufficient preliminary communication, the old man decided to use abuxitinib for treatment. After one week of use, he was very happy to tell me that the treatment was effective quickly. Moreover, except for the mild gastrointestinal discomfort at the beginning, no other adverse reactions were found. The gastrointestinal discomfort also disappeared on the 2-3 days after use. Overall, he was very satisfied with the treatment effect."
Based on the above clinical studies and clinical observations, abuxitinib has the characteristics of rapid onset of itching and clearance of skin lesions in AD treatment. The medication process is safe and controllable, which can reduce various concerns when using it. As an oral small molecule targeted drug, abuxitinib is convenient to use, and patients are highly adhered to this. Professor Wu Zhouwei said that he is very confident that abuxitinib improves the clinical drug experience and treatment outcomes of AD patients.
Expert profile
Wu Zhouwei Professor
PhD, chief physician, master's supervisor,
Executive Director of the South Hospital of Shanghai First People's Hospital
Visiting Scholars of Kyushu University and the United States MUSC
Member of the Dermatology and Venereology Branch of Shanghai Medical Association
Young Committee Member of the Dermatology Branch of the Chinese Medical Association
Young Committee Member of the Dermatology Branch of the Chinese Medical Association
Young Committee Member of the Dermatology Branch of the Chinese Medical Association
Young Committee Member of the Dermatology Branch of the Chinese Medical Association
Youth Committee Member of the Medical Aesthetics and Beauty Branch of Shanghai Medical Association
Hand Member of the Shanghai Dermatology Quality Control Expert Group
Destination of 2 National Natural Science Foundation projects, participated in the compilation of 6 monographs, and published more than 50 papers as the first author and corresponding author. Among them, SCI included more than 30 papers
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References:
[1]Zhang Jianzhong. Chinese Medical Information Guide. 2017, 32(10): 14.
[2]Liu P, et al. Chinese Medical Journal. 2016, 129(7): 757-762.
[3]Guo Y, et al. J Eur Acad Dermatol Venereol. 2019, 33(8): 1569-1576.
[4]Cheng R, et al. J Eur Acad Dermatol Venereol. 2019, doi:10.1111/jdv.15979.
[5]Immunology Group, Dermatology Branch of Chinese Medical Association, Collaborative Research Center for Atopic Dermatitis. Chinese Journal of Dermatology, 2020, 053(002): 81-88.
[6]Wollenberg A, et al. European guideline (EuroGuiDerm) on apic eczema: part I - systemic therapy. J Eur Acad Dermatol Venereol. 2022, 36(9):1409-1431.
[7]Peeva E, et al. Br J Clin Pharmacol. 2018, 84(8): 1776-1788.
[8]Simpson EL, et al. Lancet. 2020, 396: 255–66.
[9]Danese S, et al. Gut. 2019, 68(10):1893-1899.
[10]Jamilloux Y, et al. Autoimmun Rev. 2019, 18(11):102390.
[11]Silverberg JI, et al. JAMA Dermatol. 2020, 156(8):863-873.
[12]Simpson EL, et al. Am J Clin Dermatol. 2021, 22(5):693-707.
Case Statement*:
1. The case sharing and discussion involved in the article are for educational and communication purposes only, and do not involve consultation and intervention diagnosis and treatment. The relevant diagnosis and treatment decisions are made independently by the doctor based on the patient's condition.
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