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    Future of dermatologic innovation has bright spots


    house ad to dermatology subscribe pageWhile government funds for research in dermatology and other medical specialties seems to be dwindling, there are forces at work that could help to pick up at least part of the slack.

    Samantha Fernando, Ph.D., a therapy area analyst specializing in immunology for GlobalData, London, says pharmaceutical companies here and abroad are focusing more on the dermatology market in the United States.

    “Previously large companies have neglected the dermatology market. Interest, however, has recently been reignited, with pharmaceutical companies appreciating the sizable patient population and lucrative nature of the market,” she says.

    The size of dermatology patient population and increased awareness among potential patients about dermatology conditions are attractive to industry, according to Dr. Fernando.

    “I think, for the first time, we’re going to be seeing large pharmaceutical companies with dedicated R&D programs in dermatology, with significant innovation and discovery in the next 10 years,” she says.

    Helping to prove her point: GlaxoSmithKline (GSK) acquired Stiefel in 2009. The move by this pharmaceutical giant to take over one of the biggest and oldest dermatology companies is a massive stride forward, she says.

    “The dermatology field is dominated by specific players, but with a company like GSK and Novartis coming back into (the specialty), it shows this is an exciting area to be involved in,” Dr. Fernando says.

    Novel and not-so-novel innovations

    Daniel M. Siegel, M.D., M.S., clinical professor of dermatology, SUNY Downstate, says most innovation in medical dermatology has involved reformulating drugs. But, he says, there are a few novel treatments. Among those: vismodegib (Erivedge, Genentech), the first oral drug for basal cell carcinoma, as well as ingenol mebutate gel (Picato, LEO Pharma), a novel molecule for treating actinic keratosis. Ingenol mebutate might also play a role in treating nonmelanoma skin cancers, according to Dr. Siegel.

    An example of a novel use of an old drug, Dr. Siegel says, is brimonidine (Mirvaso, Galderma), which is a topical alpha agonist that reduces rosacea's redness by vasoconstriction.

    “The biggest advances in treatment are in cutaneous oncology. We’re moving more toward targeted therapies and inhibitors of inflammatory pathways,” according to George Martin, M.D., a dermatologist in Maui, Hawaii. He is also program director of the upcoming 10th Annual MauiDerm Conference in January. This year, among other presenters, Professor Eggert Stockfleth of Charite Hospital in Berlin will release the global actinic keratosis treatment guidelines.

    There are other important advances, Dr. Martin says. In psoriasis and other inflammatory disorders, anti-interleukin-17 antibodies, phosphodiesterase 4 inhibitor (PDE4) and Janus kinase inhibitors (JAK inhibitors) are showing promise.

    “We’re seeing the use of biologic agents, like rituximab used to treat lymphomas, now being used to treat inflammatory blistering diseases, such as pemphigus vulgaris. We’re also seeing pathway inhibitors and immune checkpoint modulators in the treatment of advanced melanoma,” he says. “Those are huge strides being made in our understanding of those pathways and inhibitors of those pathways.”

    Lisette Hilton
    Lisette Hilton is president of Words Come Alive, based in Boca Raton, Florida.


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