When most people experience an itch, they think nothing of it; a simple scratch can usually tame it. The itch experienced by people living with atopic dermatitis (AD), commonly known as eczema, is distinct—intense, fiery and unrelenting. It’s often severe enough to interfere with sleep and daily activities, and scratching can leave skin raw, sensitive and painful—with only fleeting relief from symptoms. AD, The most common inflammatory skin disorder worldwide, is a highly heterogeneous condition with current treatments that do not address the multiple inflammatory pathways that cause its specific symptoms.

For people with AD, Johnson & Johnson’s research offers hope for relief from persistent itching and other debilitating symptoms—which Leonetti says could lead to new beginnings.

Getty
Ahead, explore how immunology leader Johnson & Johnson is responding to this gap by investigating potential therapies that may open new frontiers in AD treatment.

The Misunderstood Physical And Mental Impact Of AD

While AD is the most common inflammatory skin disease, it remains misunderstood for several reasons, says Liza O’Dowd, M.D., Johnson & Johnson Innovative Medicine’s vice president, immunodermatology disease area leader. AD arises from an overactive immune response that damages the skin, yet obtaining an accurate diagnosis can at times be difficult because the disease can present differently in each patient. Some patients experience dry, scaly skin while others have red, swollen or weeping rashes. Symptoms can also appear irregularly throughout patients’ lives, with calmer periods punctuated by intense flare-ups.

Most importantly, says O’Dowd, the inflammation associated with AD is not always limited to the skin and can be linked to other life-threatening conditions including asthma and even cardiovascular disease. “AD should not be considered ‘just a skin rash with some itch,’” she says.

The mental toll of AD can also negatively impact daily life, says O’Dowd. People may be embarrassed by the way their skin looks and shy away from interacting with family and friends—or people may avoid them because of the misperception that AD is contagious. Along with social stigma, sleep disruptions from itching—which can intensify at night—can impact psychological well-being, O’Dowd says. “Many patients with AD have higher rates of depression, anxiety, stress and suicide,” she says.

Existing treatments for AD can be an incomplete match for a disease that can look and feel different from person to person, says O’Dowd—representing an unmet need for the estimated 101.3 million adults and 102.8 million children worldwide¹ affected globally. Some treatments may temporarily soothe symptoms but not help every patient. Other current therapies, including topical steroids or immunosuppressants, can produce unwanted side effects such as thinning or lightening of the skin and raise broader safety risks, she says.

Johnson & Johnson, known for its legacy of healthcare innovation and decades of experience in immune-mediated diseases, is investigating several potential therapies targeting different inflammatory pathways and processes, which may open promising new frontiers in AD treatment. Laura Leonetti, Johnson & Johnson Innovative Medicine’s vice president, global commercial leader, dermatology and rheumatology, explains that the company’s approach builds on discoveries about the role of immune-response pathways in causing specific symptoms, a targeted strategy that could lead to more personalized patient care.

“Having a potential treatment for patients with different types of symptoms can transform their lives,” says Leonetti.

Johnson & Johnson’s recent acquisitions and ongoing research are rooted in the knowledge that AD springs from more than one source, or pathway, in the immune system. “There are multiple pathways that drive different disease symptoms,” says Leonetti. “So, there’s a different pathway that triggers the itch and different pathway that triggers the inflammation.”

For each pathway, a specific cytokine—a linchpin protein in the immune system—takes a dominant role. Some of the interleukin (IL) group of cytokines, for instance, travel to cells to activate defense mechanisms that manifest as itching and other AD symptoms.

Johnson & Johnson is exploring how to inhibit multiple pathways, which could give patients and healthcare providers more control over symptoms, O’Dowd says. “We aim to address the unmet needs of patients with improved clinical responses and disease remissions, which are especially important for those AD patients who remain underserved with currently available treatment options,” she says.

Achieving Remission By Targeting Two Pathways At Once

A portion of Johnson & Johnson’s research in AD focuses on artificial proteins known as bispecific antibodies that, true to their name, target two immune-system pathways at the same time. Bispecifics are engineered to block pathways by binding to key cytokines or their receptors activated by exposure to allergens or the environment, thus preempting the cytokine responses that spark AD symptoms. Importantly, by design, bispecifics are thought to target selected inflammatory pathways potentially limiting broad suppression of the entire immune system.

For example, Johnson & Johnson is investigating whether disrupting both AD’s crucial IL-13 pathway and the thymic stromal lympopoietin (TSLP) cytokine involved in tissue inflammation could unlock new therapeutic options. The company has built a robust pipeline of therapeutic options that will allow further investigation into which pathway combinations yield the best results for certain sub-groups of patients.

Johnson & Johnson’s research approach in AD intentionally includes varied bispecifics and other treatment modalities with the goal of advancing a robust pipeline of potential treatments that may help manage the unique symptoms of each patient—with lasting remission as the goal, O’Dowd says.

“It would mean that their disease may be under complete control, and they can gain back a feeling of normalcy in terms of physical appearance, resolution of itching and scratching, improvement in sleep and improvement in the emotional and psychological impacts of this disease,” she says.

Leonetti says bispecifics herald the future of a more personalized approach in dermatology and compares them to recent leaps in cancer care where tailored treatment regimens have improved patient response. Eventually, this research could point to new approaches to treat asthma, an IL-driven disease afflicting more than 20% of AD patients, says O’Dowd.

For people with AD, Johnson & Johnson’s research offers hope for relief from persistent itching and other debilitating symptoms—which Leonetti says could lead to new beginnings.

“Remission from AD would allow individuals the chance to reconnect with life’s simple joys and share meaningful time with their loved ones.”