Shawn Kwatra, MD, associate professor of dermatology at Johns Hopkins University School of Medicine and director of the Johns Hopkins Itch Center, in Baltimore, Maryland, recently attended and presented at the 12th World Congress on Itch in Miami, Florida, held November 5th through the 7th. The international meeting was chaired by Gil Yosipovitch, MD, who was assisted by the local organizing committee of Galit Yosipovitch, MBA, Eng; Leigh Nattkemper, PhD; Ethan Lerner, MD, PhD; and Santosh Mishra, PhD.

At the meeting, Kwatra presented sessions on chronic itch in ethnic populations, emerging pathways in itch, and mastering itch in atopic dermatitis. Kwatra spoke alongside experts in itch, including Daniel Butler, MD; Katja Fischer, PhD; Asit Kumar Mittal, MD; Brian Kim, MD, MTR; Bernhard Homey, MD, PhD; Sarina Elmariah, MD, PhD, MPH; and many others.

Additionally, Kwatra thanks Dr Brian Kim for his dedicated session planning, as well as Sonja Stnder, MD, who presented the important work of the International Dermatology Outcomes Measures Initiative.

Transcript

Shawn Kwatra, MD: Hi I'm Shawn Kwatra, director of the Johns Hopkins Itch Center and also a dermatologist in Baltimore, Maryland.I had the pleasure of serving his faculty and speaking at an incredible meeting, the 12th World Congress on Itch in Miami, Florida, which was November 5th to 7th. I want to give a lot of credit to Dr. Gil Yosipovitch who was the chair of the meeting and who did an incredible job organizing along with Galit Yosipovitch and a great organizing committee with Leigh Nattkemper, Ethan Lerner, and Santosh Mishra, as well. And it was a very incredible meeting spanning all aspects of itch and there were actually world leaders present in many different areas. So, Dr. Brian Kim actually did an incredible job moderating a session about the basic science and neuroimmune regulation of itch. There were world leaders such as Dr. Isaac Chiu, Ru-Rong Ji, Caroline Sokol, also other big heavy hitters like Dr. Mark Hoon, Allan Basbaum, and Xinzhong Dong, so many world leaders in the basic science of itch therapeutics, neuroimmune regulation, and also sensory biology were present, which made this incredible meeting as well as many clinical leaders. So, there was Dr. Jonathan Silverberg and Dr. Amy Paller, Dr. Kenji Kabishima Dr. Sonja Stander, and Elke Weisshaar, who's the President also of the International Forum for the Study of Itch.

It was an incredible meeting that was conducted really with a lot of world leaders. And also, what was interesting was a hot topics session where there was novel data that was released. Dr. Martin Metz really talked about some novel data with the compound barzolvolimab. Tyler Beck who's also an MD, PhD, talked about a novel long-acting release kappa opioid receptor compound, so it was really a jam-packed session all about itch and even talking about the definition of itch upfront by Dr. Sonja Stander as well. Just great sessions across the board at a very high level from both basic science and clinical perspective as well. These are the kinds of meetings where a lot of breakthroughs happen because a lot of collaborations are made. So, it's really an incredible meeting. And I want to make sure I give a lot of credit to Dr. Gil Yosipovitch, Galit Yosipovitch, and all of those other folks who helped organize just a tremendous meeting there are nearly 500 people that attended a strong industry presents as well as well as world leaders, folks from all over the world. It puts itch on the map. We know that there are many therapeutics that are in development for itch and many more coming. This is a huge unmet need in medicine broadly. I think having that industry support is also very important. And it was just a phenomenal meeting

Dermatology Times: What clinical pearls did you share at the 12th World Congress on Itch?

Kwatra: I actually had the pleasure to talk about itch in skin color and ethnic populations. And this is a huge unmet need because what we know is in diseases like atopic dermatitis, the disease disproportionately affects this patient population. There are higher rates of eczema in Black children and adults. Folks are more likely to have persistent atopic dermatitis and develop subsequent asthma as well. And we know that they're actually also important factors genetics, social determinants of health, environment, even exposure to an urban microbiome. And we also know these patients are oftentimes prescribed a lot of our novel cutting-edge therapeutics at less frequent rates. It's a major issue. We also talked about prurigo nodularis, which disproportionately affects Black patients. And these patients actually have a broader immune activation. We shared some novel data from our lab that shows Black patients oftentimes present with more fibrotic nodules as well. So we shared data how in atopic dermatitis, there may be broader immune activation and actually papular involvement that can be on a continuum with prurigo nodularis, and then we shared data how in prurigo nodularis, there are actually genetic studies that are group performed showing that Asian and African patients are more likely to develop PN in the first place, so a genetic polygenic risk score, they present and predicted development. And we also share data on our somatic mutation study. This is work funded by the National Institutes of Health, the Dermatology Foundation, and the Skin of Color Society. So a large coalition of funding that showed in African American patients, there are very unique genes involving epithelial and mesenchymal transition that are affected as well as novel, copy number variations, and we also shared a little bit of our data where we have been following prurigo nodularis patients prospectively and performing immunophenotyping of these patients and also characterizing their response to therapy.

One thing that we are finding is that there seems to be race-based endotypes of the disease in different subsets of patients. So particularly, Asian and Caucasian patients tend to have a little bit higher degree of circulating blood type 2 inflammation than our African American patients. We're excited we'll be sharing more of this data in a more complete manner also at the Skin of Color Society Scientific Symposium at the American Academy of Dermatology, the day before that meeting, so it's a very good opportunity to talk about itch in skin of color, and we highlighted some nuances to treatment. You want to have less of reliance on topical steroids because of the risk of hyperpigmentation. You want to aggressively target inflammation and you also want to view itch as a biomarker or a sensor of disease activity because you can't actually see the erythema as well, the redness as well in skin of color patients, particularly our African American and Black. patients. So knowing that there may be a barrier there, and then acting appropriately; we're prioritizing itch by asking about the symptom, because we know that's also associated with inflammation, so it was a great session. And great to actually get a lot of folks thinking about this topic especially in clinical trials. We alluded to the problem that we're having with the limited numbers of enrollment of minority populations and pivotal phase 3 trials. So, there have been the development of some post approval phase 4 studies, but we also discussed and highlighted how the true goal is to have in our pivotal phase 3 studies, very representative populations and minority populations that mirror you know, the general population as well. We know how these drugs are working properly. We had a great discussion about many different aspects from society to bench to bedside.

[Transcript edited for clarity]

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