Looking Under the Surface in Pediatric Atopic Dermatitis

This activity is jointly provided by Global Education Group and Integritas Communications.

This activity is supported by an educational grant from Sanofi Genzyme and Regeneron Pharmaceuticals.

MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com

FACULTY FACULTY

Lawrence F. Eichenfield, MD

Professor of Dermatology and Pediatrics Vice Chair, Department of Dermatology Chief, Pediatric and Adolescent Dermatology Rady Children’s Hospital University of California, San Diego, School of Medicine San Diego, California

Dr. Lawrence Eichenfield is Chief of Pediatric and Adolescent Dermatology at Rady Children’s Hospital–San Diego, Vice Chair of the Department of Dermatology, and Professor of Dermatology and Pediatrics at the University of California, San Diego (UCSD) School of Medicine. He received his medical degree from Mount Sinai School of Medicine in New York, was a pediatric resident and Chief Resident at Children’s Hospital of Philadelphia, and completed his dermatology residency at the Hospital of the University of Pennsylvania.

Dr. Eichenfield’s clinical interests include atopic dermatitis, acne, psoriasis, vascular lesions including port wine stains and hemangiomas, neonatal dermatology, laser surgery, nevi, and skin signs of systemic disease. He has authored more than 400 journal articles, chapters, abstracts, and books on these topics and has served as the senior editor of Neonatal and Infant Dermatology, published by Elsevier, as well as The Eczemas, published by Summit Communications. He served as Editor-in-Chief of Pediatric Dermatology for 12 years and serves on the editorial boards of multiple journals and periodicals.

In addition, Dr. Eichenfield has been honored as a member of the Alpha Omega Alpha Medical Honor Society during medical school, as a recipient of the Benjamin Ritter Award at Children’s Hospital of Philadelphia, and as a recipient of excellence in teaching awards from UCSD Pediatrics, UCSD Dermatology, and Rady Children’s Hospital–San Diego. He has been named one of the “Best Doctors in America” since 1994. Dr. Eichenfield is past president of the Society for Pediatric Dermatology and past Board member of the American Academy of Dermatology as well as Chair for the 69th Annual Meeting of the American Academy of Dermatology. Dr. Eichenfield is also a founding board member of the American Acne and Rosacea Society, and a founder and past Co-Chair of the Pediatric Dermatology Research Alliance (PeDRA).

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Anthony J. Mancini, MD, FAAP, FAAD FACULTY

Head, Division of Dermatology, Ann & Robert H. Lurie Children’s Hospital of Chicago Professor of Pediatrics and Dermatology Northwestern University Feinberg School of Medicine Chicago, Illinois

Dr. Anthony Mancini is Professor of Pediatrics and Dermatology at Northwestern University Feinberg School of Medicine and Head of the Division of Pediatric Dermatology at Ann & Robert H. Lurie Children’s Hospital of Chicago, where he directs the division’s pediatric dermatology fellowship training program. He is a Fellow of both the American Academy of Dermatology and the American Academy of Pediatrics (AAP).

Dr. Mancini’s clinical and research interests include infantile hemangiomas, atopic dermatitis, exanthems of childhood, and neonatal skin maturation and skin disorders. He has published over 220 peer-reviewed articles, abstracts, books, and book chapters. He is coauthor of Hurwitz Clinical Pediatric Dermatology (3rd, 4th, 5th, and upcoming 6th editions), coeditor of the AAP publication Pediatric Dermatology: A Quick Reference Guide (1st, 2nd, and 3rd editions), and Pediatric Section Editor of Dermatology (1st, 2nd and 3rd editions).

Dr. Mancini is the Past President of the Society for Pediatric Dermatology, where he also served for 10 years as Secretary-Treasurer, and past Chair of the 2017 World Congress of Pediatric Dermatology. He has previously served on the AAP Executive Committee of the Section on Dermatology, the AAP Super CME Planning Group, and the AAP PediaLink Pediatric Dermatology Project Team, and is an author of the recently published AAP Clinical Practice Guidelines on Infantile Hemangiomas.

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Gaspar Rivera, MD, MPH, FAAP FACULTY

General Pediatrician San Ysidro Health Chula Vista, California

Dr. Gaspar Rivera is a graduate of University of California at Irvine (UCI) School of Medicine as part of the Program in Medical Education for the Latino Community (PRIME-LC). He completed his Master of Public Health at the University of California Los Angeles (UCLA) Fielding School of Public Health and trained in Pediatrics at the University of California at San Francisco (UCSF) Benioff Children’s Hospital Oakland. Dr. Rivera received the Kerry Spooner-Dean, MD, Memorial Award for Commitment to Primary Care and Community Service at UCSF Benioff Children’s Hospital Oakland.

After completing his residency, Dr. Rivera stayed at UCSF Benioff Children’s Hospital Oakland for a year. He subsequently moved to San Diego County and has been practicing as a General Pediatrician at a Federally Qualified Health Center with San Ysidro Health since October 2017. San Ysidro Health serves a predominantly Spanish-speaking underserved population near the border in San Ysidro and other areas in San Diego.

Dr. Rivera is a fellow of the American Academy of Pediatrics. He is the first in his family to become a physician. He is currently a Steven M. Thompson Physician Corps Loan Repayment Program Recipient.

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TARGET AUDIENCE The educational design of this activity addresses the needs of pediatricians and other clinicians who treat pediatric and adolescent patients with moderate-to-severe atopic dermatitis.

EDUCATIONAL OBJECTIVES After completing this activity, the participant should be better able to:

PREAMBLE

•• Describe the pathophysiologic mechanisms and risk factors associated with atopic dermatitis, including the rationales for targeted therapies •• Longitudinally assess children and adolescents with atopic dermatitis for uncontrolled symptoms, comorbid conditions, and other biopsychosocial consequences for patients and their families •• Discuss the clinical profiles, trial data, and prescribing considerations for targeted therapies for pediatric and adolescent patients with moderateto-severe atopic dermatitis •• Individualize therapeutic regimens for moderate-to-severe atopic dermatitis across pediatric health care settings based on ongoing symptoms, burdens, comorbidities, and shared clinical decision-making

STATEMENT OF NEED/PROGRAM OVERVIEW Atopic dermatitis is a common, chronic, inflammatory disease that manifests primarily in the skin, although research has uncovered potentially deleterious effects in other organ systems throughout the body.1,2 The disease-related physical and biopsychosocial burdens of this condition can have substantial effects on patient and parent/caregiver quality of life, particularly in pediatric and adolescent patients with moderate-to-severe disease. 3,4 A better understanding of disease etiology has supported the development of new approaches to disease characterization and targeted therapies. 5,6 As a result, the first biologic therapy is now available to treat adult patients with moderate-to-severe disease. Further, this biologic therapy and other advanced treatments are currently under investigation for pediatric and adolescent patients, with some positive outcomes recently reported.7-9 With novel therapies emerging for pediatric and adolescent patients with difficult-to-treat atopic dermatitis, attendees will benefit from updates on the latest clinical trial data, treatment guidelines, and practical recommendations on how to translate this information into daily clinical decision-making.10 In this Collaborative Care Symposium™, a panel of recognized pediatric dermatology experts will review the latest evidence with the goal of providing recommendations to enhance overall patient outcomes. The faculty panel will discuss the pathophysiologic underpinnings of atopic dermatitis, best practices in comprehensive patient

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evaluations, and the latest evidence relating to disease management and referral for young patients with moderate-to-severe disease. In the final segment of the program, attendees will gain valuable insights as faculty members convey their own clinical experiences during discussions of representative case studies.

1. Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015:66(suppl 1):8-16.

2. Brunner PM, et al. Increasing comorbidities suggest that atopic dermatitis is a systemic disorder. J Invest Dermatol. 2017;137(1):18-25.

3. Carroll CL, et al. The burden of atopic dermatitis: impact on the patient, family, and society. Pediatr Dermatol. 2005;22(3):192-199.

4. Drucker AM, et al. The burden of atopic dermatitis: summary of a report for the National Eczema Association.

J Invest Dermatol. 2017;137(1):26-30.

5. Mansouri Y, Guttman-Yassky E. Immune pathways in atopic dermatitis, and definition of biomarkers through broad and targeted therapeutics. J Clin Med. 2015;4(5):858-873.

6. Gandhi NA, et al. Targeting key proximal drivers of type 2 inflammation in disease. Nat Rev Drug Discov.

2016;15(1):35-50.

7. Paller, AS, et al. Therapeutic pipeline for atopic dermatitis: end of the drought? J Allergy Clin Immunol.

2017;140(3):633-643.

8. Simpson EL, et al. Dupilumab efficacy and safety in adolescents with moderate-to-severe atopic dermatitis: results from a multicenter, randomized, placebo-controlled, double-blind, parallel-group, phase 3 study.

Presented at the 27th EADV Congress. September 12-16, 2018, Paris, France. Poster #4640.

9. Cotter DG, et al. Emerging therapies for atopic dermatitis: JAK inhibitors. J Am Acad Dermatol.

2018;78(3 suppl 1):S53-S62.

10. AriĂŤns LFM, et al. Dupilumab in atopic dermatitis: rationale, latest evidence and place in therapy.

Ther Adv Chronic Dis. 2018;9(9):159-170.

PHYSICIAN ACCREDITATION STATEMENT 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 the joint providership of Global Education Group (Global) and Integritas Communications.

Global is accredited by the ACCME to provide continuing medical education for physicians.

This CME/CE activity complies with all requirements of the federal Physician Payment Sunshine Act. If a reportable event is associated with this activity, the accredited provider managing the program will provide the appropriate physician data to the Open Payments database.

PHYSICIAN CREDIT DESIGNATION Global Education Group designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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PREAMBLE

REFERENCES

GLOBAL CONTACT INFORMATION For information about the accreditation of this program, please contact Global at 303-395-1782 or cme@globaleducationgroup.com.

INSTRUCTIONS TO RECEIVE CREDIT In order to receive credit for this activity, the participant must complete the program evaluation.

FEE INFORMATION & REFUND/ CANCELLATION POLICY PREAMBLE

There is no fee for this educational activity.

DISCLOSURE OF CONFLICTS OF INTEREST Global Education Group (Global) requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by Global for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity: Lawrence F. Eichenfield, MD Consultant: Allergan Plc; Anacor Pharmaceuticals Inc.; Dermavant Sciences, Inc.; Dermira, Inc.; DS Biopharma Limited; Eli Lilly and Company; FortĂŠ Pharma Laboratories; Galderma Laboratories, L.P.; Incyte Corporation; LEO Pharma, Inc.; MatriSys Bioscience, Inc.; Medimetriks Pharmaceuticals, Inc.; Menlo Therapeutics Inc.; Novan, Inc.; Novartis AG; Ortho Dermatologics, Inc.; Otsuka Pharmaceutical Co., Ltd.; Pfizer Inc.; Regeneron Pharmaceuticals; Sanofi Genzyme; TopMD; DSM: Glenmark Pharmaceuticals Inc.; Investigator: LEO Pharma, Inc.; Regeneron Pharmaceuticals; Sanofi Genzyme; Advisory Board: Ortho Dermatologics, Inc. Equity Options: TopMD; Honoraria: Allergan Plc; Anacor Pharmaceuticals Inc.; Dermavant Sciences, Inc.; Dermira, Inc.; DS Biopharma Limited; Eli Lilly and Company; FortĂŠ Pharma Laboratories; Galderma Laboratories, L.P.; Glenmark Pharmaceuticals Inc.; Incyte Corporation; LEO Pharma, Inc.; MatriSys Bioscience, Inc.; Medimetriks Pharmaceuticals, Inc.; Menlo Therapeutics Inc.; Novan, Inc.; Novartis AG; Ortho Dermatologics, Inc.; Otsuka Pharmaceutical Co., Ltd.; Pfizer Inc.; Regeneron Pharmaceuticals; Sanofi Genzyme; Speakers Bureau: Ortho Dermatologics, Inc.

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Anthony Mancini, MD. FAAP, FAAD Consultant: Pfizer Inc.; Verrica Pharmaceuticals Inc. Gaspar Rivera, MD, MPH, FAAP Nothing to disclose

Lindsay Borvansky

Nothing to disclose

Andrea Funk

Nothing to disclose

Liddy Knight

Nothing to disclose

Ashley Cann

Nothing to disclose

Stacey Ullman, MHS

Nothing to disclose

PREAMBLE

The planners and managers reported the following financial relationships or relationships to products or devices they or their spouses/life partners have with commercial interests related to the content of this CME activity:

DISCLOSURE OF UNLABELED USE This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the US Food and Drug Administration. Global Education Group (Global) and Integritas Communications do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

DISCLAIMER Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed in this activity should not be used by clinicians without evaluation of patient conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

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GUIDELINES »» Guidelines of care for the management of atopic dermatitis: part 1. Diagnosis and assessment of atopic dermatitis.

Eichenfield LF, et al. J Am Acad Dermatol. 2014;70(2):338-351. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410183/pdf/nihms598033.pdf

»» Guidelines of care for the management of atopic dermatitis: part 2. Management and treatment of atopic dermatitis with topical therapies.

Eichenfield LF, et al. J Am Acad Dermatol. 2014;71(1):116-132. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4326095/pdf/nihms598590.pdf

»» Guidelines of care for the management of atopic dermatitis: part 3. Management and treatment with phototherapy and systemic agents.

Sidbury R, et al. J Am Acad Dermatol. 2014;71(2):327-349. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4410179/pdf/nihms-598620.pdf

»» Guidelines of care for the management of atopic dermatitis: part 4. Prevention of disease flares and use of adjunctive therapies and approaches.

Sidbury R, et al. J Am Acad Dermatol. 2014;71(6):1218-1233. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430554/pdf/nihms685688.pdf

»» Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. Wollenberg A, et al. J Eur Acad Dermatol Venereol. 2018;32(5):657-682.

RESOURCE CENTER

https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.14891

»» Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. Wollenberg A, et al. J Eur Acad Dermatol Venereol. 2018;32(6):850-878. https://onlinelibrary.wiley.com/doi/epdf/10.1111/jdv.14888

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PATIENT RESOURCES »» The Society for Pediatric Dermatology

Established in 1975, the mission of the Society for Pediatric Dermatology is to advance the specialty through education and research, to develop new means of treatment, and to provide advocacy in support of pediatric patients with skin, hair, and nail disorders.

Informative patient education videos have been developed for patients with atopic dermatitis and their families. https://pedsderm.net/for-patients-families/patient-education-videos/#Eczema

»» International Eczema Council

Founded in late 2014, the International Eczema Council (IEC) is a global nonprofit organization led by dermatology experts on atopic dermatitis.

The IEC is dedicated to increasing the understanding of atopic dermatitis and promoting its optimal management through research, education, and patient/family care. http://www.eczemacouncil.org/for-patients/

»» National Eczema Association

The National Eczema Association is a nonprofit organization founded in 1988 to improve the health and quality of life for individuals with eczema through research, support, and education. www.nationaleczema.org

CLINICAL ASSESSMENT TOOLS »» Children’s Dermatology Life Quality Index (CDLQI)

https://www.cardiff.ac.uk/medicine/resources/dermatology-questionnaires/ childrens-dermatology-life-quality-index

»» Eczema Area and Severity Index (EASI)

EASI is a clinician assessment tool designed to measure clinical severity of atopic dermatitis. Severity scores can range from 0 (clear) to 72 (very severe).

Hanifin JM, et al. Exp Dermatol. 2001;10(1):11-18. http://www.homeforeczema.org/documents/easi-case-report-form-for-age-8years-and-over.pdf

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RESOURCE CENTER

CDLQI is 10-question patient-reported assessment tool designed to measure impact of any skin disease on the lives of children ages 4-16.

Lewis-Jones MS, Finlay AY. Br J Dermatol. 1995;132(6):942-949.

»» Investigator Global Assessment (IGA)

The IGA is a clinician assessment strategy designed to provide a snapshot of overall disease severity in dermatologic clinical trials.

Futamura M, et al. J Am Acad Dermatol. 2016;74(2):288-294. http://www.pubmed.gov/26685719

»» Patient-Oriented Eczema Measure (POEM)

The POEM is a patient-oriented, self-assessed measurement tool for monitoring aspects of atopic dermatitis in routine clinical practice or in the clinical trial setting.

Charman CR, et al. Arch Dermatol. 2004;140(12):1513-1519. https://www.nottingham.ac.uk/research/groups/cebd/resources/poem.aspx

»» Scoring Atopic Dermatitis (SCORAD)

SCORAD is a clinical tool used to assess the extent and severity of eczema.

Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology.

1993;186(1):23-31. http://adserver.sante.univ-nantes.fr/Compute.html

SUGGESTED READING Atopic Dermatitis Overview and Pathogenesis »» Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis.

Kong HH, et al. Genome Res. 2012;22(5):850-859. https://genome.cshlp.org/content/22/5/850.full.pdf

RESOURCE CENTER

»» Identification of atopic dermatitis subgroups in children from 2 longitudinal birth cohorts.

Paternoster L, et al. J Allergy Clin Immunol. 2018:141(3):964-971. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840507/?report=reader

»» Pathogenesis of atopic dermatitis.

Peng W, Novak N. Clin Exp Allergy. 2015;45(3):566-574. https://onlinelibrary.wiley.com/doi/epdf/10.1111/cea.12495

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Patient Burden and Comorbidities »» The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis.

Chamlin SL, et at. Arch Pediatr Adolesc Med. 2005;159(8):745-750. https://jamanetwork.com/journals/jamapediatrics/fullarticle/486092

»» Bidirectional relationships between psychological health and dermatological conditions in children.

Mitchell AE. Psychol Res Behav Manag. 2018;11:289-298. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6074762/pdf/prbm-11-289.pdf

»» Association of inadequately controlled disease and disease severity with patient-reported disease burden in adults with atopic dermatitis.

Simpson EL, et al. JAMA Dermatol. 2018;154(8):903-912. https://jamanetwork.com/journals/jamadermatology/fullarticle/2686155

»» Mental health comorbidity in patients with atopic dermatitis.

Yaghmaie P, et al. J Allergy Clin Immunol. 2013;131(2):428-433.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3565469/pdf/nihms-429164.pdf

Management of Atopic Dermatitis »» Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial.

Blauvelt A, et al. Lancet. 2017;389(10086):2287-2303.

»» Atopic dermatitis yardstick: practical recommendations for an evolving therapeutic landscape.

Boguniewicz M, et al. Ann Allergy Asthma Immunol. 2018;120(1):10-22. https://www.annallergy.org/article/S1081-1206(17)31260-7/pdf

»» Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement.

Drucker AM, et al. Br J Dermatol. 2018;178(3):768-775. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5901393/

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RESOURCE CENTER

https://www.ncbi.nlm.nih.gov/pubmed/28478972

»» Translating atopic dermatitis management guidelines into practice for primary care providers.

Eichenfield LF, et al. Pediatrics. 2015;136(3):554-565. http://pediatrics.aappublications.org/content/pediatrics/136/3/554.full.pdf

»» Application of moisturizer to neonates prevents development of atopic dermatitis.

Horimukai K, et al. J Allergy Clin Immunol. 2014;134(4):824-830.e6. https://www.ncbi.nlm.nih.gov/pubmed/25282564

»» Treatment of Staphylococcus aureus colonization in atopic dermatitis decreases disease severity.

Huang JT, et al. Pediatrics. 2009;123(5):e808-e814. https://www.ncbi.nlm.nih.gov/pubmed/19403473

»» Anti-interleukin-31 receptor A antibody for atopic dermatitis.

Ruzicka T, et al. N Engl J Med. 2017;376(9):826-835.

https://www.ncbi.nlm.nih.gov/pubmed/?term=28249150

»» When does atopic dermatitis warrant systemic therapy?

Recommendations from an expert panel of the International Eczema Council.

Simpson EL, et al. J Am Acad Dermatol. 2017;77(4):623-633. https://www.jaad.org/article/S0190-9622(17)31944-8/pdf

»» Two phase 3 trials of dupilumab versus placebo in atopic dermatitis.

Simpson EL, et al. N Engl J Med. 2016;375(24):2335-2348.

RESOURCE CENTER

www.pubmed.gov/27690741

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