Therapeutic areas in focus
‘Cumulative life course impairment’: The unforeseen burdens of severe eczema
AbbVie’s Rachael Millward takes a deep dive into dermatitis, patient impact, and patient expectations – and how a healthcare professional might meet them
What are some of the unexpected complexities of skin conditions such as atopic dermatitis?
Atopic dermatitis (AD) is a common chronic inflammatory skin disease with a complex pathogenesis. The severity of the disease varies widely but AD can affect multiple aspects of a patient’s life from the skin manifestations such as the characteristic rash and itching, to less visible impact; such as depression, anxiety, and lack of sleep. AD is what is known as an atopic disease, and is commonly related to other atopic disease such as asthma, allergic rhinitis and in some cases food allergies. Interestingly, Abbvie has conducted a database analysis to further characterise potential comorbidities associated with AD using two distinct databases, CPRD and HES. This analysis has revealed some interesting insights such as observing an increase in the reporting of inflammatory bowel disease as the severity of AD increases. We need to do more research to understand the overlapping immune pathways across the immune mediated diseases to deepen our understanding of such diseases.
AbbVie focuses on dermatological areas with high unmet medical need – which areas within dermatology have you identified on these lines, and why do they qualify?
AbbVie has had long heritage in immunology, but with a dermatology focus for around 20 years. As mentioned AD can have a significant burden on patients lives, added with the complexity of the AD pathogenesis and limited treatment options, there has been a high unmet need for these patients. Some AD patients can be incredibly unwell, with 60% of patients with severe AD talk about their symptoms as unbearable or unrelenting. You can imagine the onward impact of that in terms of things like sleeping, work productivity. For me, focusing on AD and the high unmet need is key and fundamental.
AbbVie also work in delivering treatment areas where current options do not meet patient expectations – can you speak a little on the importance of meeting these expectations, and the current difficulties in delivering on them?
Centrally we need to listen to our patients and understand what they need to do be able to manage their disease. We can assume patients want to be completely free of their disease, however what they actually want could be a good night’s sleep; to wear a dress to go to a wedding or a birthday party; to wake up and feel refreshed and take their kids to school. Small things that can mean a lot to patients. When we look at the patient research we’ve conducted in AD, we often hear patients talk about their desire for freedom from the relentless itching, not being able to sleep, not being able to be productive at work, not being able to concentrate. Patient often talk about feeling embarrassed by their condition, particularly if the rash is on a highly visible areas – on your hands, your face, your legs, skin clearance, for example, could be an ambition we should be aiming towards. At AbbVie, we set out to make a remarkable impact on patients’ lives, and as we innovate and understand immune mediate disease better, we should be asking ourselves: are we meeting the needs of our patients?
What are some of the most serious implications for those who suffer serious chronic skin conditions? How can healthcare professionals work to decrease their severity?
The serious implications are that skin conditions are often dismissed quite early on. One of the biggest barriers for patients, especially for patients with severe skin disease, is being referred to a specialist. Patients can spend a significant period of time in a primary care setting and not receiving the care they require. Sadly some patients may never get to see a specialist, and can drop out of the care system all together, and then we hear of patients self-managing the condition. We need to work in partnership, to allow patients access to a specialist when they need it, and not allow the fact it’s a skin condition to prevent that from happening.
Those patients who do enter into the secondary care system, it’s vital they’re given time with their healthcare professional to talk about how best to manage their conditions as each patient is different and the impact of the disease can vary from patient to patient. Small, but effective, steps, such as educating patients on how to optimise their topical
treatments can be vital. For example, patients are often not given any instruction of how much emollient to use on or how much of the affected skin. Simple steps can really help patients gain control of their disease, however time and resource constraints make this difficult in practice.
But, beyond the healthcare system, certainly the symptomatic relief of the condition itself, and always reminding ourselves that some of these patients have been living with this condition for a very long time and have adapted to cope with the condition. When aiming for holistic care, there are many factors that need to be considered, such as the age of the patient, visible signs and symptoms, and emotional wellbeing. It is well documented that AD can have huge psychological impact on patients, but it is not often part of the management plan. Access to psychodermatology clinics for complex patients have demonstrated significant improvements and have provided patients coping mechanisms to support the management of their disease. Unfortunately, this service is not widely available to the patients who need it. Budget cuts have made it particularly hard for departments to offer this valuable service.
We strive to support patients and healthcare stakeholders to access the Future of Better Care, Quicker; focusing on the need to secure better outcomes for patients by working in partnership with healthcare stakeholders.
Between 11-20% of children in the UK suffer from AD, and 2% of these cases are severe. How are AbbVie working to address this long-term condition, and what are its impacts?
AD has quite a high prevalence in adolescents and children and can manifests itself very early in a patient’s life and the effects of AD on children can have lifelong implications. The concept of cumulative life course impairment is interesting, whereby children with AD may not achieve certain milestones when compared to patients of the same age without AD, because of the profound negative impact of the disease. Educating on this concept and managing the disease early and effectively could reduce the overall impact the disease has on children over the long term.
What recent innovations in the treatments of long-term skin conditions have you been particularly excited by?
It is fantastic to see significant investment being made to advance innovation and management of skin diseases in general, there are myriad skin conditions now being investigated and prioritised, many with significant patient burden and with an associated high unmet need, AD is just one of such conditions.
is currently head of medical affairs for immunology at AbbVie UK, where the team are working on a wide range of immune mediated inflammatory diseases. Rachael has held various roles, across multiple organisations, ranging from clinical research, pharmacovigilance, medical information, and latterly medical affairs. Rachael’s academic background and research interests are in biotechnology and molecular genetics with a particular focus on pluripotent stem cells. For more information, contact:
SKIN DISEASE TREATMENTS
Dermatologically speaking: Finding new treatments for women
Pharmafile sat down with the team at Organon to unearth the different ways that women’s dermatological conditions can be successfully supported and managed
What is the future plan for expanding the range of treatments available to women with dermatological conditions?
Simon Nicholson, Managing Director UK&ENI Cluster:
Essentially, we are a women’s health company built on three pillars: women’s health, biosimilars and established medications. We have a strong foundation of more than 60 medicines across a range of areas including contraception, reproductive health, menopause, cardiovascular disease, dermatology, allergy and asthma, to name a few.
Our mission is to deliver impactful medicines and solutions every day for every woman. Our focus for the future is not limited, but our commitment remains to listen to women and identify areas of unmet need. This will drive our investment and our future portfolio.
How does dermatitis and other skin conditions affect those suffering from them?
Manjit Aujla, Lead Established Brands & Biosimilars UK-ENI:
Dermatitis and other skin inflammatory conditions can have a real impact on self-esteem and confidence, and in extreme cases the psychological impact can be far reaching with some people experiencing depression and anxiety.
A person’s long-term well-being can be impaired by skin conditions. These can have a profound effect on all aspects of people’s lives, including personal relationships and social engagement. Improvements in awareness of skin conditions, and access to specialist services including psychological interventions, can be helpful in both treating and coping with many skin conditions.
What would you say is the greatest challenge faced by women suffering from skin conditions?
Faye Sheen, Brand and Customer Manager UK and Ireland:
It is very difficult to talk about one single challenge that women with skin conditions face as every part of their life can be affected – including relationships, careers, self-confidence, mental health, and in some cases, this could have an indirect impact on wider family members quality of life.
Depression and anxiety are probably the greatest challenge for women suffering from skin conditions as this can affect women’s ability to work and study, and can have a major impact on family and social life. Women with skin conditions may want to cover up or shy away from social interactions.
What are the priorities in this area?
It is now five months since we launched Organon, and we launched with a commitment to identify the unmet needs in the women’s health space, by really listening to women and all our key stakeholders. We have continually sought the views of women through many channels, and it is clear there are a number of significant areas of unmet need in both the provision of solutions to treat conditions which specifically affect women, but also those which have a disproportionate effect on women. The biggest challenge for us moving forward will be to prioritise our efforts and ensure we are supporting women in the areas of greatest need, at the right time and in the right way. An example
of this is the impact of COVID-19 on sexual health services, which in turn impacted access to contraception and resulted in a substantial increase in unplanned pregnancies across the world.
The biggest challenge for us moving forward will be to prioritise our efforts and ensure we are supporting women in the areas of greatest need, at the right time and in the right way
On World Contraception Day, we partnered with The Faculty of Sexual and Reproductive Health to shine a light on the challenges that women have faced through this disruption, and as part of a major initiative to improve access to LARCs, we have been pioneering the development of a new treatment pathway in Liverpool. By igniting the conversation around contraception, we hope to empower women with the knowledge that they need to understand the contraceptive options that are available to them.
More recently, on World Menopause Day, we listened to women between the ages of 40-60 – undoubtedly a time in a woman’s life that can be really challenging. Our survey results confirmed that although there is still need for further education, when women feel supported, it can also be a time of real empowerment and a milestone that positively opens the door to the next chapter of their lives.
Our next major milestone is International Women’s Day on March 8. We will be continuing to give women a voice, and continuing to listen so that we can make a material difference and create a better, and healthier, every day for every woman. This is just the beginning for us as a women’s health company. There is much more to come.
is the Managing Director of the UK & ENI Cluster at Organon, with over 14 years of experience in the pharmaceutical industry. Simon is committed to making life better for each and every woman.
is the Brand and Customer Manager UK and Ireland at Organon. Faye has a strong focus on supporting women, ensuring that women’s voices are heard, and is keen to make sure that Organon reflects what women want.
is the Lead of Established Brands and Biosimilars UK & ENI at Organon, with over 13 years of experience in the pharmaceutical industry. Manjit has a particular interest in multi-channel marketing and integration.
VIRTUAL DERMATOLOGICAL ENGAGEMENT
Insight and oversight: Making the most of virtual platforms in dermatology
FIDE is an independent expert-led consultancy, specialising in providing insight into inflammatory skin conditions. Dr Bruce E Strober, Executive Director, takes a look at virtual communication with HCPs and patients, and offers insight into how to make the most out of virtual communications with dermatologists, HCPs, and patients
What has the impact of restricted one-to-one healthcare professional (HCP) access engagement been on dermatological patient care?
Dr Bruce Stober:
We have observed minimal effect – our practice has functioned mostly normally (with appropriate COVID-19 precautions in place) for the past 18 months.
Some restrictions have been placed on the number of pharma reps to keep density down. We’re actually busier than ever with patient care, and allow in-person interaction with pharmaceutical representatives. Truth be told, some restriction on pharmaceutical interaction is positive, as it can be overwhelming to a busy HCP trying to conduct patient care.
COVID-19 restrictions have also limited knowledge transfer – what effect has this had on dermatological R&D and patient care?
The lack of in-person meetings has necessitated virtual learning, which isn’t vastly inferior. However, in-person learning likely fosters more Q&A and discussion that is somewhat blunted by the virtual medium. Patient care likely hasn’t been impacted significantly. The real issue is how COVID-19 has delayed the FDA review process, inhibiting the approval of important new medications for patients in need.
Dermatology is an area with significant unmet patient needs. What is needed to provide access to expert insight, and how do you work to ensure it?
To really get to the bottom of unmet patient needs efficiently, it is vital for biopharmaceutical companies to develop relationships with a variety of HCPs who can provide unbiased insights on the market
landscape. These insights are crucial for uncovering real challenges across the patient and healthcare professional journey. It is only by truly listening that organisations can develop solutions that can improve the lives of patients.
As a consultant I regularly interact with pharmaceutical companies of all types and sizes to help ensure more sensible product development and commercialisation. I also participate in numerous virtual continuous medical education (CME) and promotional activities that foster education and discussion.
Which areas of dermatology are neglected in terms of research and development, and patient care?
Some rare skin conditions, such as lichen planus, scarring alopecia, granuloma annulare, and hypersenstivity dermatitis (that primarily affects older individuals), are overlooked. These conditions are often tough to treat and require a lot of trial and error approaches. They also often face treatment failure. Further, medications that might be effective, without FDA approval for these uses, are hard to deliver to patients.
What have the most interesting developments in dermatology been over this time period, and what changes do you anticipate in the next ten years?
Without a doubt, the advancement of psoriasis therapeutics, which are now very effective and safe, and the incipient development of effective therapies for atopic dermatitis. The next 10 years will see further advancements in atopic dermatitis, hidradenitis suppurativa, alopecia areata, and vitiligo. Further, there appears to be a revolution brewing in the development of novel topical drugs with safe and effective mechanisms of action and can treat inflammatory dermatitis.
What are some of the ways dermatologists can adjust to the challenges presented to them in patient care through the COVID-19 pandemic?
In the US, COVID-19 has not recently impacted dermatology, with many practices quite busy. It appears that business has returned to normal. In essence, we are learning to live with COVID-19, instituting the correct precautions along the way.
What difficulties have arisen in educating HCPs in managing skin conditions over the past few years?
While allowing learning in the comfort of one’s own home or office, the movement to virtual media, due to lack of good engagement, is an inferior approach to in-person conferences and symposia. It is a mixed bag, as the lack of travel is, on balance, easier on lifestyle and happiness. HCPs who are disciplined and engaged can still learn a lot from the current virtual educational offerings.
What is your number one piece of advice for biopharmaceutical companies looking to enhance their relationship with dermatologists today?
Keep the interaction data driven, with honest presentations of your drug/agent – no tricks and over-commercialised approaches that don’t jibe well with reality. Also, focus on patients who have comorbidities – work with registries and other repositories of realworld data to get an idea of how the drug really works when used in clinical practice.
Dr Bruce E Strober
Executive Director at FIDE, is Clinical Professor of Dermatology at Yale University School of Medicine, and practices at Central Connecticut Dermatology. He is also co-Scientific Director of the CorEvitas psoriasis registry, Treasurer of the International Psoriasis Council, and Editor in chief of the Journal of Psoriasis and Psoriatic Arthritis. Dr Strober earned both his medical degree and his doctorate from Columbia University College of Physicians and Surgeons in New York. He completed his residency in dermatology at the Department of Dermatology, New York University School of Medicine. He is certified by the American Board of Dermatology and is a Fellow of the American Academy of Dermatology.
To find out more about FIDE, contact: