Clear Targets 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.

This virtual symposium is not sponsored, endorsed, or accredited by the American Academy of Pediatrics.

CME/MEDICAL COMMUNICATIONS INQUIRIES info@integritasgrp.com integritasgrp.com 2

FACULTY

Peter A. Lio, MD

Clinical Assistant Professor of Dermatology and Pediatrics Feinberg School of Medicine Northwestern University Director, Chicago Integrative Eczema Center Founding Partner, Medical Dermatology Associates of Chicago Chicago, Illinois Dr. Peter Lio is a clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine.

Dr. Lio received his medical degree from Harvard Medical School, completed his internship in Pediatrics at Boston Children’s Hospital, and his Dermatology training at Harvard, where he served as Chief Resident in Dermatology. While at Harvard, he received formal training in acupuncture. Dr. Lio is the founding director of the Chicago Integrative Eczema Center and a founding partner of Medical Dermatology Associates of Chicago. He currently serves as a board member and scientific advisory committee member for the National Eczema Association. A member of the American Academy of Dermatology’s Atopic Dermatitis Expert Resource Group and a founding faculty member of the Integrative Dermatology Certificate Program, Dr. Lio has published over 200 papers and 3 textbooks.

Corinna Rea, MD, MPH

Assistant Professor, Harvard Medical School Director, General Academic Pediatric Fellowship Boston Children’s Hospital Boston, Massachusetts

Dr. Corinna Rea is a general pediatrician and the Fellowship Director of the General Academic Pediatric Fellowship at Boston Children’s Hospital. She has a particular interest in atopic dermatitis (AD), and sees patients with AD in a specialized clinic within primary care to provide extended support and education. She has developed and published on multiple educational and clinical tools related to AD with colleagues in Dermatology and Allergy, including an Eczema Care Plan, an educational handbook, and a hospital-wide clinical pathway. She also created an electronic consultation and referral system to improve communication and coordination between primary care providers and subspecialists within Boston Children’s Hospital.

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Anne Marie Singh, MD Associate Professor of Pediatrics Director, Food Allergy Research and Education Center of Excellence University of Wisconsin School of Medicine & Public Health Madison, Wisconsin

Dr. Anne Marie Singh is an associate professor of pediatrics in the Division of Allergy, Immunology, and Rheumatology, a Food Research Institute Affiliate, and the Director of the Food Allergy Research and Education Center of Excellence at the University of Wisconsin-Madison. After completing her allergy-immunology fellowship and postdoctoral training at the University of WisconsinMadison, Dr. Singh joined the faculty at Northwestern University Feinberg School of Medicine for 8 years, returning to the University of Wisconsin in 2017. Her research program is focused on atopic dermatitis and food allergy, including studies to advance clinical care, as well as mechanistic studies on how environmental and microbial exposures affect disease. She performs translational and clinical studies to better understand food allergy, atopic dermatitis, and early life wheezing.

TARGET AUDIENCE The educational design of this activity addresses the needs of pediatricians and other clinicians who are involved in the management of pediatric patients with atopic dermatitis.

PROGRAM DESCRIPTION This Case-in-Point™ program features an expert panel with a general pediatrician and 2 pediatric specialists to address the challenges in treating young patients with moderate-to-severe atopic dermatitis. Faculty will discuss 3 cases of children with atopic dermatitis, comorbid asthma, and allergies, as well as diseaserelated psychosocial burden. This virtual symposium will cover the pathophysiologic underpinnings of atopic dermatitis, best practices in patient evaluation, common atopic and nonatopic comorbidities, clinical trial evidence for new and emerging pharmacotherapies, and recommended management strategies that emphasize shared decision-making with patients (and their caregivers) and a multidisciplinary approach in cases of more severe disease.

EDUCATIONAL OBJECTIVES Upon completion of this activity, participants will be better able to • Differentially diagnose atopic dermatitis in pediatric patients, including identification of disease severity, phenotypes, and appropriate therapeutic interventions • Compare the efficacy and safety of traditional immunosuppressive modalities and biologic treatment options in moderate-to-severe atopic dermatitis • Individualize treatment regimens for pediatric patients with moderate-to-severe atopic dermatitis to reflect disease presentation, comorbidities, and shared decision-making • Discuss how to coordinate the ongoing management of moderateto-severe atopic dermatitis based on communication and shared decision-making with patients, caregivers, and other clinicians

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.

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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NURSE PRACTITIONER CONTINUING EDUCATION This activity has been planned and implemented in accordance with the Accreditation Standards of the American Association of Nurse Practitioners (AANP) through the joint providership of Global Education Group and Integritas Communications. Global Education Group is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 110121.

This activity is approved for 1.5 contact hour(s) (which includes 0.0 hour(s) of pharmacology).

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

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

FEE INFORMATION & REFUND/ CANCELLATION POLICY There is no fee for this educational activity.

DISCLOSURE OF CONFLICTS OF INTEREST Global Education Group (Global) adheres to the policies and guidelines, including the Standards for Integrity and Independence in Accredited CE, set forth to providers by the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous. All persons in a position to control the content of an accredited continuing education program provided by Global are required to disclose all financial relationships with any ineligible company within the past 24 months to Global. All financial relationships reported are identified as relevant and mitigated by Global in accordance with the Standards for Integrity and Independence in Accredited CE in advance of delivery of the activity to learners. The content of this activity was vetted by Global to assure objectivity and that the activity is free of commercial bias.

All relevant financial relationships have been mitigated.

The faculty have the following relevant financial relationships with ineligible companies: Peter A. Lio, MD Consultant: AbbVie, Almirall, Amyris, AOBiome, ASLAN, Bodewell, Burt’s Bees, Dermavant, Eli Lilly, Exeltis, Galderma, IntraDerm, Johnson & Johnson, LEO, L’Oréal, Menlo Therapeutics, Micreos (stock options), Pierre Fabre, Pfizer, Realm Therapeutics, Regeneron/Sanofi Genzyme, Theraplex, Unilever; Contracted Research: AbbVie, AOBiome, Regeneron/Sanofi Genzyme; Speakers Bureau: Eli Lilly, Galderma, LEO, L’Oréal, Pfizer, Regeneron/Sanofi Genzyme; Stock Shareholder: Altus Labs, Micreos; Royalty: Theraplex AIM OTC ointment Anne Marie Singh, MD

Consulting Fee: AbbVie

Corinna Rea, MD, MPH

Nothing to disclose

The planners and managers have the following relevant financial relationships with ineligible companies: Kristin Delisi, NP

Nothing to disclose

Lindsay Borvansky

Nothing to disclose

Andrea Funk

Nothing to disclose

Liddy Knight

Nothing to disclose

Ashley Cann

Nothing to disclose

Kim Rodriguez

Nothing to disclose

Stacey Ullman

Nothing to disclose

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.

» 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

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. 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

PATIENT RESOURCES » Patient Handout: Helping Your Pediatric Patients and Their Families Understand Systemic Therapy for Moderate-toSevere Atopic Dermatitis https://www.exchangecme.com/resourcePDF/derm/ADPatientHandout.pdf

» The Society for Pediatric Dermatology Established in 1975, the Society for Pediatric Dermatology provides resources for patients and families to help them with dermatologic issues. https://pedsderm.net/for-patients-families/

» 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. https://www.eczemacouncil.org/

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CLINICAL ASSESSMENT TOOLS » Children’s Dermatology Life Quality Index (CDLQI) The CDLQI is 10-question patient-reported assessment tool designed to measure impact of any skin disease on the lives of children aged 4-16 years.

Lewis-Jones MS, Finlay AY. Br J Dermatol. 1995;132(6):942-949. https://www.cardiff.ac.uk/medicine/resources/quality-of-life-questionnaires/ childrens-dermatology-life-quality-index

» Eczema Area and Severity Index (EASI) The 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

» 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-assessment 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

» 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

» 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

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.

» 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. www.pubmed.gov/27690741

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

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

Boguniewicz M, et al. Ann Allergy Asthma Immunol. 2018;120(1):10-22.e2. 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/

» 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

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Please visit the CLINICAL RESOURCE CENTER for additional information and resources

www.ExchangeCME.com/ AtopicDermResources21

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