METHOD FOR TARGETED TREATING DERMATOSES

Abstract

Disclosed are methods for localized treatment of a skin condition including administering a therapeutically effective amount of at least one Janus kinase inhibitor (JAKi) to the subject, utilizing a dosimetry device to transmit varying percentages of the UVB light to an area of the subject's skin; assessing a response of the treated area to the varying percentages of the UVB light transmitted thereto; and determining an optimal dose of UVB light, based on the response of the treated area to the varying percentages of UVB light and to the JAKi; and applying the optimal dose of UVB light to the treatment area.

Claims

1-40. (canceled)

41. A method for localized treatment of a skin condition, the method comprising the steps of: a. administering a therapeutically effective amount of at least one Janus kinase inhibitor (JAKi) to the subject, b. utilizing a dosimetry device, comprising an optical matrix comprising a plurality of regions, each region configured to allow varying percentages of UVB light to pass therethrough, to transmit varying percentages of the UVB light to an area of the subject's skin; c. assessing a response of the treated area to the varying percentages of the UVB light transmitted thereto; d. determining an optimal dose of UVB light, based on the response of the treated area to the varying percentages of UVB light and to the JAKi; and e. applying the optimal dose of UVB light to the treatment area.

42. The method of claim 41, wherein the optimal dose of UVB light is the maximum tolerable dose of INB light and wherein the method further comprises determining an optimal amount of the JAKi based on the determined maximum tolerable dose of UVB light.

43. The method of claim 41, wherein the transmission of light passing through the regions ranges from about 20% in one region up to about 100% in another region.

44. The method of claim 41, wherein the UVB light is UVB laser light having a wavelength of about 290-320 nm and an intensity of 60 mwatts.

45. The method of claim 41, wherein the administering of the JAKi and the applying of the maximum tolerable dose of UVB light is repeated 1-5 times a week.

46. The method of claim 41, wherein the assessing of the response of the treatment area to the varying percentages of the UVB light transmitted utilizing the dosimetry device is repeated at least every two weeks and wherein adjusting the maximum tolerable dose of UVB light, is based on the repeated assessment of the response of the treatment area to the varying percentages of the UVB light.

47. The method of claim 41, further comprising adjusting the therapeutically effective amount of at least one JAKi, based on the repeated assessment of the response of the treatment area to the varying percentages of the UVB light.

48. The method of claim 41, wherein the administering of the therapeutically effective amount of the at least one JAKi is initiated at least 1 week prior to the transmitting of the varying percentages of UVB light to a treatment area and the assessment of the response of the treated area to the varying percentages of the UVB light transmitted thereto.

49. The method of claim 41, wherein the at least one JAKi is selected from the group consisting of tofacitinib, ruxolitinib, oclacitinib, baricitinib, filgotinib gandotinib, lestaurtinib, momelotinib, pacritinib, upadacitinib (ABT-494), peficitinib, cucurbitacin I, CHZ868, fedratinib, cerdulatinib, ATI-50001, Leo-124429, or a salt or solvate thereof.

50. The method of claim 41, wherein the at least one JAKi is tofacitinib, or a salt or solvate thereof and wherein the subject is administered about 5-20 mg/day of tofacitinib or wherein the at least one JAKi is ruxolitinib, or a salt or solvate thereof and wherein the subject is administered about 5-50 mg/day of ruxolitinib.

51. The method of claim 41, wherein the skin condition is selected from vitiligo, psoriasis, leukoderma, atopic dermatitis, dyshidrosis, eczema, alopecia areata and lichen planus.

52. The method of claim 51, wherein the skin condition is vitiligo or psoriasis.

53. A method for localized treatment of a skin condition, the method comprising the steps of: a. utilizing a dosimetry device, comprising an optical matrix comprising a plurality of regions, each region configured to allow varying percentages of UVB light to pass therethrough, to transmit varying percentages of the UVB light to an area of the subject's skin affected with the skin condition; b. assessing a response of the skin area to the varying percentages of the UVB light transmitted thereto; c. determining an optimal dose of UVB light, based on the response of the treated skin area to the varying percentages of UVB light; d. determining an optimal dose of Janus kinase inhibitor (JAKi), based on the determined optimal dose of UVB light; e. administering the optimal dose of JAKi to the subject, and f. treating the skin area with the optimal dose of UVB light.

54. The method of claim 53. wherein the optimal dose of UVB light is the maximum tolerable dose of UVB light.

55. The method of claim 53, wherein the transmission of light passing through the regions ranges from about 20% in one region up to about 100% in another region.

56. The method of claim 53, wherein the UVB light is UVB laser light having a wavelength of about 290-320 nm and an intensity of 60 mwatts.

57. The method of claim 53, wherein the at least one JAKi is selected from the group consisting of tofacitinib, ruxolitinib, oclacitinib, baricitinib, filgotinib, gandotinib, lestaurtinib, momelotinib, pacritinib, upadacitinib (ABT-494), pefcitinib, cucurbitacin I, CHZ868, fedratinib, cerdulatinib ATI-50001, Leo-124429, or a salt or solvate thereof.

58. The method of claim 57. wherein the at least one JAKi is tofacitinib or ruxolitinib, or a salt or solvate thereof.

59. The method of claim 53, wherein the skin condition is selected from vitiligo, psoriasis, leukoderma, atopic dermatitis, dyshidrosis, eczema, alopecia areata and lichen planus.

60. The method of claim 59, wherein the skin condition is vitiligo or psoriasis.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0072] Some embodiments of the disclosure are described herein with reference to the accompanying figures. The description, together with the figures, makes apparent to a person having ordinary skill in the art how some embodiments of the disclosure may be practiced. The figures are for the purpose of illustrative discussion and no attempt is made to show structural details of an embodiment in more detail than is necessary for a fundamental understanding of the teachings of the disclosure. For the sake of clarity, some objects depicted in the figures are not to scale.

[0073] FIG. 1 is a perspective view of the hand-held phototherapy delivery apparatus and an embodiment of an end piece with a circular diaphragm connected thereto for beam shaping;

[0074] FIG. 2A is a front view of an embodiment of the dosimetry device of the present invention illustrating an embodiment of the photosensitivity matrix;

[0075] FIG. 2B is an end view of the matrix of FIG. 2A;

[0076] FIG. 3 is a flowchart of a method for localized treatment of a skin condition; according to some embodiments;

[0077] FIG. 4 is a flowchart of a method for localized treatment of a skin condition; according to some embodiments;

[0078] FIG. 5 is a flowchart of a method for localized treatment of a skin condition; according to some embodiments;

[0079] FIG. 6 is a flowchart of a method for localized treatment of a skin condition; according to some embodiments;

[0080] FIG. 7 is a flowchart of a method for treatment of a skin condition; according to some embodiments;

[0081] FIG. 8 is a flowchart of a method for treatment of a skin condition; according to some embodiments.

DETAILED DESCRIPTION

[0082] In the following description, various aspects of the disclosure will be described. For the purpose of explanation, specific configurations and details are set forth in order to provide a thorough understanding of the different aspects of the disclosure. However, it will also be apparent to one skilled in the art that the disclosure may be practiced without specific details being presented herein. Furthermore, well-known features may be omitted or simplified in order not to obscure the disclosure.

[0083] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which the invention pertains.

[0084] The articles “a” and “an” are used herein to refer to one or to more than one (i.e. to at least one) of the grammatical object of the article. By way of example, “an element” means one element or more than one element.

[0085] Unless specifically stated or obvious from context, as used herein, the term “about” is understood as within a range of normal tolerance in the art, for example within 2 standard deviations of the mean. “About” can be understood as within 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, 0.5%, 0.1%, 0.05%, or 0.01% of the stated value. Unless otherwise clear from context, all numerical values provided herein are modified by the term “about”.

[0086] As used herein “Janus kinase” or “JAK” means a member of the tyrosine kinase family of genes or proteins that are important for cytokine signaling.

[0087] By “Janus kinase 1” or “Janus kinase type 1” or “JAK1” is meant the member of the JAK family having the following sequence for the human polypeptide, SEQ ID NO: 1

TABLE-US-00001 MQYLNIKEDCNAMAFCAKMRSSKKTELEAPEPGVEVIFYLSDREPLRLGS GEYTAEELCIRAAQACRISPLCHNLFALYDENTKLWYAPNRTITVDDKMS LRLHYRMRFYFTNWHGTNDNEQSVWRHSPKKQKNGYEKKKIPDATPLLDA SSLEYLFAQGQYDLVKCLAPIRDPKTEQDGHDIENECLGMAVLAISHYAM MKKMQLPELPKDISYKRYIPETLNKSIRQRNLLTRMRINNVFKDFLKEFN NKTICDSSVSTHDLKVKYLATLETLTKHYGAEIFETSMLLISSENEMNWF HSNDGGNVLYYEVMVTGNLGIQWRHKPNWSVEKEKNKLKRKKLENKHKKD EEKNKIREEWNNFSYFPEITHIVIKESWSINKQDNKKMELKLSSHEEALS FVSLVDGYFRLTADAHHYLCTDVAPPLIVHNIQNGCHGPICTEYAINKLR QEGSEEGMYVLRWSCTDFDNILMTVTCFEKSEQVQGAQKQFKNFQIEVQK GRYSLHGSDRSFPSLGDLMSHLKKQILRTDNISFMLKRCCQPKPREISNL LVATKKAQEWQPVYPMSQLSFDRILKKDLVQGEHLGRGTRTHIYSGTLMD YKDDEGTSEEKKIKVILKVLDPSHRDISLAFFEAASMMRQVSHKHIVYLY GVCVRDVENIMVEEFVEGGPLDLFMHRKSDVLTTPWKFKVAKQLASALSY LEDKDLVHGNVCTKNLLLAREGIDSECGPFIKLSDPGIPITVLSRQECIE RIPWIAPECVEDSKNLSVAADKWSFGTTLWEICYNGEIPLKDKTLIEKER FYESRCRPVTPSCKELADLMTRCMNYDPNQRPFFRAIMRDINKLEEQNPD IVSEKKPATEVDPTHFEKRFLKRIRDLGEGHFGKVELCRYDPEGDNTGEQ VAVKSLKPESGGNHIADLKKEIEILRNLYHENIVKYKGICTEDGGNGIKL IMEFLPSGSLKEYLPKNKNKINLKQQLKYAVQICKGMDYLGSRQYVHRDL AARNVLVESEHQVKIGDFGLTKAIETDKEYYTVKDDRDSPVFWYAPECLM QSKFYIASDVWSFGVTLHELLTYCDSDSSPMALFLKMIGPTHGQMTVTRL TLKEGKRLPCPPNCPDEVYQLMRKCWEFQPSNRTSFQNLIEGFEALLK

[0088] By “Janus kinase 2” or “Janus kinase type 2” or “JAK2” is meant the member of the JAK family having the following sequence for the human polypeptide, SEQ ID NO: 2

TABLE-US-00002 MGMACLTMTEMEGTSTSSIYQNGDISGNANSMKQIDPVLQVYLYHSLGKS EADYLTFPSGEYVAEEICIAASKACGITPVYHNMFALMSETERIWYPPNH VFHIDESTRHNVLYRIRFYFPRWYCSGSNRAYRHGISRGAEAPLLDDFVM SYLFAQWRHDFVHGWIKVPVTHETQEECLGMAVLDMMRIAKENDQTPLAI YNSISYKTFLPKCIPAKIQDYHILTRKRIRYRFRRFIQQFSQCKATARNL KLKYLINLETLQSAFYTEKFEVKEPGSGPSGEEIFATIIITGNGGIQWSR GKHKESETLTEQDLQLYCDFPNIIDVSIKQANQEGSNESRWTIHKQDGKN LEIELSSLREALSFVSLIDGYYRLTADAHHYLCKEVAPPAVLENIQSNCH GPISMDFAISKLKKAGNQTGLYVLRCSPKDFNKYFLTFAVERENVIEYKH CLITKNENEEYNLSGTKKNFSSLKDLLNCYQMETVRSDNIIFQFTKCCPP KPKDKSNLLVFRTNGVSDVPTSPTLQRPTHMNQMVFHKIRNEDLIFNESL GQGTFTKIFKGVRREVGDYGQLHETEVLLKVLDKAHRNYSESFFEAASMM SKLSHKHLVLNYGVCVCGDENILVQEFVKFGSLDTYLKKNKNCINILWKL EVAKQLAWAMHFLEENTLIHGNVCAKNILLIREEDRKTGNPPFIKLSDPG ISITVLPKDILQERIPWVPPECIENPKNLNLATDKWSFGTTLWEICSGGD KPLSALDSQRKLQFYEDRHQLPAPKWAELANLINNCMDYEPDFRPSFRAI IRDLNSLFTPDYELLTENDMLPNMRIGALGFSGAFEDRDPTQFEERHLKF LQQLGKGNFGSVEMCRYDPLQDNTGEWAVKKLQHSTEEHLRDFEREIEIL KSLQHDNIVKYKGVCYSAGRRNLKLIMEYLPYGSLRDYLQKHKERIDHIK LLQYTSQICKGMEYLGTKRYIHRDLATRNILVENENRVKIGDFGLTKVLP QDKEYYKVKEPGESPIFWYAPESLTESKFSVASDVWSFGWLYELFTYIEK SKSPPAEFMRMIGNDKQGQMIVFHLIELLKNNGRLPRPDGCPDEIYMIMT ECWNNNVNQRPSFRDLALRVDQIRDNMAG

[0089] By “Janus kinase 3” or “Janus kinase type 3” or “JAK3” is meant the member of the JAK family having the following sequence for the human polypeptide, SEQ ID NO: 3

TABLE-US-00003 MAPPSEETPLIPQRSCSLLSTEAGALHVLLPARGPGPPQRLSFSFGDHLA EDLCVQAAKASGILPVYHSLFALATEDLSCWFPPSHIFSVEDASTQVLLY RIRFYFPNWFGLEKCHRFGLRKDLASAILDLPVLEHLFAQHRSDLVSGRL PVGLSLKEQGECLSLAVLDLARMAREQAQRPGELLKTVSYKACLPPSLRD LIQGLSFVTRRRIRRTVRRALRRVAACQADRHSLMAKYIMDLERLDPAGA AETFHVGLPGALGGHDGLGLLRVAGDGGIAWTQGEQEVLQPFCDFPEIVD ISIKQAPRVGPAGEHRLVTVTRTDNQILEAEFPGLPEALSFVALVDGYFR LTTDSQHFFCKEVAPPRLLEEVAEQCHGPITLDFAINKLKTGGSRPGSYV LRRSPQDFDSFLLTVCVQNPLGPDYKGCLIRRSPTGTFLLVGLSRPHSSL RELLATCWDGGLHVDGVAVTLTSCCIPRPKEKSNLIWQRGHSPPTSSLVQ PQSQYQLSQMTFHKIPADSLEWHENLGHGSFTKIYRGCRHEWDGEARKTE VLLKVMDAKHKNCMESFLEAASLMSQVSYRHLVLLHGVCMAGDSTMVQEF VHLGAIDMYLRKRGHLVPASWKLQWKQLAYALNYLEDKGLPHGNVSARKV LLAREGADGSPPFIKLSDPGVSPAVLSLEMLTDRIPWVAPECLREAQTLS LEADKWGFGATVWEVFSGVTMPISALDPAKKLQFYEDRQQLPAPKWTELA LLIQQCMAYEPVQRPSFRAVIRDLNSLISSDYELLSDPTPGALAPRDGLW NGAQLYACQDPTIFEERHLKYISQLGKGNFGSVELCRYDPLGDNTGALVA VKQLQHSGPDQQRDFQREIQILKALHSDFIVKYRGVSYGPGRQSLRLVME YLPSGCLRDFLQRHRARLDASRLLLYSSQICKGMEYLGSRRCVHRDLAAR NILVESEAHVKIADFGLAKLLPLDKDYYWREPGQSPIFWYAPESLSDNIF SRQSDVWSFGWLYELFTYCDKSCSPSAEFLRMMGCERDVPALCRLLELLE EGQRLPAPPACPAEVHELMKLCWAPSPQDRPSFSALGPQLDMLWSGSRGC ETHAFTAHPEGKHHSLSFS

[0090] As used herein, the term “pharmaceutical composition” or “composition” refers to a mixture of at least one compound and/or composition useful within the invention with a pharmaceutically acceptable carrier. The pharmaceutical composition facilitates administration of the compound and/or composition to a subject.

[0091] As used herein, the term “pharmaceutically acceptable carrier” means a pharmaceutically acceptable material, composition or carrier, such as a liquid or solid filler, stabilizer, dispersing agent, suspending agent, diluent, excipient, thickening agent, solvent or encapsulating material, involved in carrying or transporting a compound and/or composition useful within the invention within or to the patient such that it may perform its intended function. Each carrier must be “acceptable” in the sense of being compatible with the other ingredients of the formulation, including the compound and/or composition useful within the invention, and not injurious to the patient.

[0092] The terms “pharmaceutically effective amount” and “effective amount” refer to a nontoxic but sufficient amount of an agent to provide the desired biological result. That result can be reduction and/or alleviation of the signs, symptoms, or causes of a disease or disorder, or any other desired alteration of a biological system. An appropriate effective amount in any individual case may be determined by one of ordinary skill in the art using routine experimentation.

[0093] The term “phototherapy” as used herein refers to controlled and/or prescribed application of light from an artificial light source to an area of a patient's skin in order to derive a therapeutic benefit.

[0094] As used herein, the terms “ultraviolet light” or “UV” refers to light with a wavelength between 10 and 400 nm, including, but not limited to, ultraviolet B (UVB, 280-320 nm) and ultraviolet A (UVA, 320-400 nm) and narrow regions thereof, e.g., narrowband ultraviolet B (nbUVB, 311-312 nm) and UVA1 (340-400 nm).

[0095] According to some embodiments, the hereindisclosed method includes providing, to a subject in need thereof, a JAK inhibitor (JAKi). According to some embodiments, the JAKi may be any known or heretofore unknown JAKi. In other embodiments, the JAKi is at least one selected from the group consisting of: tofacitinib, ruxolitinib, oclacitinib, baricitinib, filgotinib, gandotinib, lestaurtinib, momelotinib, pacritinib, peficitinib, CHZ868, fedratinib, cerdulatinib, ATI-50001 (Aclaris Therapeutics 's JAKi), Leo-124429 (LeoPharma's JAKi), or a salt or solvate thereof.

[0096] In certain embodiments, the JAKi is tofacitinib, or a salt or solvate thereof. In other embodiments, the JAKi is ruxolitinib, or a salt or solvate thereof.

[0097] In certain embodiments, the at least one JAKi is a specific inhibitor to one or more of JAKI, JAK2, JAK3, or tyrosine kinase (Tyk) 2. In other embodiments, the at least one JAKi is a non-specific inhibitor. In embodiments including more than one JAKi, multiple inhibitor types can be utilized. In certain embodiments, the JAKi is administered in a pharmaceutical composition comprising one or more pharmaceutically acceptable excipients. In other embodiments, the JAKi is administered orally. In yet other embodiments, the JAKi is administered topically. In yet other embodiments, topical ruxolitinib is administered to the subject as a 1.5% cream. In yet other embodiments, the JAKi is administered intralesionally. In yet other embodiments, the JAKi is administered subcutaneously.

[0098] According to some embodiments, the JAKi may be administered in a composition providing sustained release. As used herein, the term “sustained release” refers to a drug formulation that provides for gradual release of a drug over an extended period of time, and that may, although not necessarily, result in substantially constant blood levels of a drug over an extended time period. The period of time may be as long as a month or more and should be a release which is longer that the same amount of agent administered in bolus form.

[0099] For sustained release, the compounds may be formulated with a suitable polymer or hydrophobic material that provides sustained release properties to the compounds. As such, the compounds for use with the method of the invention may be administered in the form of microparticles, for example, by injection or in the form of wafers or discs by implantation.

[0100] According to some embodiments, the JAKi may be administered in a composition providing delayed release. As used herein, the term “delayed release” refers to a drug formulation that provides for an initial release of the drug after some delay following drug administration and that may, although not necessarily, includes a delay of from about 10 minutes up to about 12 hours.

[0101] Dosing the therapeutically effective amount or dose of a compound of the present invention depends on the age, sex and weight of the patient, the current medical condition of the patient and the progression of a disease or disorder contemplated in the invention. The skilled artisan is able to determine appropriate dosages depending on these and other factors.

[0102] A suitable dose of a compound of the present invention may be in the range of from about 0.01 mg to about 5,000 mg per day, such as from about 0.1 mg to about 1,000 mg, for example, from about 1 mg to about 500 mg, such as about 5 mg to about 250 mg per day. The dose may be administered in a single dosage or in multiple dosages, for example from 1 to 4 or more times per day. When multiple dosages are used, the amount of each dosage may be the same or different. For example, a dose of 1 mg per day may be administered as two 0.5 mg doses, with about a 12-hour interval between doses.

[0103] It is understood that the amount of compound dosed per day may be administered, in non-limiting examples, every day, every other day, every 2 days, every 3 days, every 4 days, or every 5 days.

[0104] In certain embodiments, the compounds of the invention are administered to a patient, alone or in combination with another pharmaceutical agent,

[0105] In certain embodiments, the phototherapy is ultraviolet B (UVB, 280-320 nm) phototherapy. In other embodiments, the phototherapy is narrowband ultraviolet B (nbUVB, 311-312 nm) phototherapy. In yet other embodiments, the phototherapy is ultraviolet A (UVA, 320-340 nm) phototherapy. In yet other embodiments, the phototherapy is ultraviolet Al (UVA1, 340-400 nm) phototherapy. In yet other embodiments, the phototherapy is visible light (400-700 nm) phototherapy. In yet other embodiments, the phototherapy is a combination of phototherapies, including, but not limited to, those listed above.

[0106] According to some embodiments, the UVB light is UVB laser light. According to some embodiments, an excimer laser is used to generate the UVB laser light, although any other laser, capable of emitting light in the UVB range, is also envisaged and, as such, encompassed by the present disclosure. An excimer laser is a laser which uses a rare-gas halide or rare-gas metal vapor and emits laser light in the ultraviolet (126 to 558 nm) range. The laser used should operate in a range between 290 and 320 nm in wavelength, the UVB range of light. The laser should be utilized at a setting of not more than 120 mwatts. According to some embodiments, the laser is a 308 nm excimer laser.

[0107] As used herein, the term “conjunction” with regards to JAK inhibitors administered to the subject in conjunction with the phototherapy, refers to a treatment regimen including the administering of JAK inhibitors and phototherapy in such manner that at least one of the treatments effects the other, e.g. in such manner that the effect of the JAK inhibitor is enhanced by the phototherapy, in such manner that the JAIL inhibitor affects the phototherapy (for example the tolerance to the phototherapy) and. the like.

[0108] According to some embodiments, the treatments may be provided essentially simultaneously. As a non-limiting example, the JAK inhibitor may be administered shortly (e.g. 0-5 hours) before (or after) the phototherapy. According to some embodiments, the treatments may be provided sequentially. As a non-limiting example, the JAK inhibitor may be administered before or after (a day before, a day after, a week before or a week after) the phototherapy. According to some embodiments, the treatments may he provided sequentially during part of the regimen and simultaneously during other parts of the regimen. As a non-limiting example, the JAK inhibitor may initially be provided alone (e.g. for a week prior to the phototherapy) whereafter the treatments are provided essentially simultaneously (e.g. administration of the JAKi shortly before the phototherapy).

[0109] According to some embodiments, the methods further comprise the administration of a therapeutically effective amount of at least a second pharmaceutical agent, such as, but not limited to a systemic drug or a biologic.

[0110] According to some embodiments, the systemic drug may be selected from the group consisting of Methotrexate, Acitretin, Isotretinoin, Tegison, Cyclosporine, Apremilast, any pharmaceutically acceptable prodrug, metabolite, polymorph, salt, solvate (e.g., hydrate) or clathrate thereof and combinations thereof. Each possibility is a separate embodiment.

[0111] According to some embodiments, the biological drug may be selected from the group of: alefacept, etanercept, adalimumab, infliximab, ustekinumab and any combination thereof. Each possibility is a separate embodiment.

[0112] According to some embodiments, the at least at least two pharmaceutical agents may be administered together. According to some embodiments, the at least two pharmaceutical agents may be administered sequentially (e.g. a systemic/biological drug may be administered 1 week before/after or 1 month before/after administration of the JAKi).

[0113] According to some embodiments, the at least one additional therapeutic agent (systemic/biologic) may enhance the influence of the JAKi on the phototherapy (e.g. further increase its efficiency) and vice-versa. According to some embodiments, the at least one additional therapeutic agent (systemic/biologic) may reduce/contradict the influence of the JAKi on the phototherapy (e.g. reduce the increased efficiency caused by treatment of the JAKi and phototherapy) and vice-versa.

[0114] According to some embodiments, determining the optimal dose of UVB may be influenced by it being administered in conjunction with a biologic and/or a systemic drug in addition to the JAKi. According to some embodiments, the optimal dose of the JAKi may be influenced by the coadministration of phototherapy and/or the systemic drug and/or biological drug. According to some embodiments, the optimal dose of the systemic drug may be influenced by the coadministration with phototherapy and/or biological drug and/or JAKi. According to some embodiments, the optimal dose of the biological drug may be influenced by the coadministration with phototherapy and/or systemic drug and/or JAKi.

[0115] Reference is now made to FIG. 1, which illustratively depicts a hand-held phototherapy delivery apparatus 100 including a dosimetry device 200, configured to distribute a dose of light energy into a plurality of doses of varying levels of light energy that can then be applied onto a treatment area simultaneously or sequentially, to determine an optimum therapeutic dose of phototherapy for an individual suffering from a skin condition, by measuring the individual's treatment response, e.g. minimum blistering dose. By treating an individual suffering from a skin condition at or near their minimum blistering dose, the overall number of treatment sessions required to place the individual's diseased skin into remission can be greatly reduced, while burning of the individual's skin can be substantially reduced, and in most instances avoided.

[0116] As seen in FIG. 2A and FIG. 2B, dosimetry device 200 includes a housing 220 that is configured to be releasably connected to phototherapy delivery apparatus 100. Dosimetry device 200 includes a sensitivity matrix 240 arranged within housing 220. Housing 220 is here depicted as being cylindrical. However, any other shapes, including, but not limited to, square, rectangular, elliptical, triangular, and trapezoidal are also envisaged and, as such, within the scope of this disclosure. Sensitivity matrix 240 can be connected (permanently or releasably) to housing 220 in any known manner.

[0117] Sensitivity matrix 240 is comprised of a plurality of regions 26, 28, 30, 32, 34, 36, 38, 40, 42 that are each designated to allow a prescribed intensity of light to pass therethrough and thus to assess an individual's maximum tolerated dose and in turn optimally to treat the patient at their maximum tolerable dose. Sensitivity matrix 240 is here depicted to include nine regions. However, matrix 240 can be comprised of any number of regions that can be arranged in any desired pattern to change what would have otherwise been a single unique dose level into an array of multiple dose levels simultaneously covering the range of potentially applicable therapeutic treatment levels.

[0118] According to some embodiments, regions 26, 28, 30, 32, 34, 36, 38, 40, 42 of sensitivity matrix 240 are comprised of absorptive and/or reflective material that allows for varying intensities of light to pass therethrough. In another embodiment, regions 26, 28, 30, 32, 34, 36, 38, 40, 42 of sensitivity matrix 240 are each comprised of partially transmissive material or filters that allows for varying intensities of light to pass therethrough.

[0119] According to some embodiments, sensitivity matrix 240 is comprised of fused silica optical components. According to some embodiments, regions 26, 28, 30, 32, 34, 36, 38, 40, 42 of sensitivity matrix 240 can be comprised of totally and/or partially reflective materials. The reflective materials can be a dielectric interference filter (e.g., partial reflector). According to some embodiments, the filter can be a multi-dielectric interference filter. According to some embodiments, the filter can be a metallic coating, including a dielectric enhanced metallic reflector. According to some embodiments, the filter can be metallic and comprised of materials such as aluminum or silver. In an embodiment, the filter can be a combination of dielectric interference filter, a multi-dielectric interference filter and a metallic coating.

[0120] According to some embodiments, the filters reflect a fraction of a dose of energy between about 0% and 99% and segment the dose into multiple beams or streams of energy of varying intensities and transmit the multiple beams or streams of energy of varying intensities onto an individual.

[0121] According to some embodiments, the intensity of light that is able to pass through regions 26, 28, 30, 32, 34, 36, 38, 40, 42 of sensitivity matrix 240 can range from approximately about 20% to 100%. According to some embodiments, the intensity of light that is able to pass through regions 26, 28, 30, 32, 34, 36, 38, 40, 42 of sensitivity matrix 240 can range from approximately about 20% to 90%. However, the number, shape and intensity of light being permissible to pass through the region 26, 28, 30, 32, 34, 36, 38, 40, 42 of sensitivity matrix 240 can vary and be greater or smaller than the numbers described herein.

[0122] The method for providing localized treatment of a skin condition is further elaborated on in the below described flowcharts. The flow charts are, for clarity reasons, described as separate embodiments. However, a person of ordinary skill in the art may understand that steps of one method may be incorporated into or substitute a step of another method, and such incorporation/substitution is thus a part of the present disclosure. It is further understood that whereas some steps are obviously sequential, the order of others may be changed and/or be performed simultaneously

[0123] Reference is now made to FIG. 3, which is a flowchart of a method 300 for localized treatment of a skin condition; according to some embodiments.

[0124] In step 310 of the method a therapeutically effective amount of a JAKi is administered to the subject. According to some embodiments, the JAKi may be a JAK1 inhibitor. According to some embodiments, the JAKi may be a JAK2 inhibitor. According to some embodiments, the JAKi may be selected from the group consisting of tofacitinib, ruxolitinib, oclacitinib, baricitinib, filgotinib, gandotinib, lestaurtinib, momelotinib, pacritinib, upadacitinib (ABT-494), peficitinib, cucurbitacin I, CHZ868, fedratinib, cerdulatinib, ATI-50001, Leo-124429, or a salt or solvate thereof. According to some embodiments, the JAKi may be tofacitinib, or a salt or solvate thereof. According to some embodiments, the JAKi, administered to the subject in step 310, may be administered at a concentration of about 5-20 mg/day of tofacitinib. According to some embodiments, the JAKi may be ruxolitinib, or a salt or solvate thereof. According to some embodiments, the JAKi administered to the subject in step 310, may be administered at a concentration of about 5-50 mg/day of ruxolitinib.

[0125] Following administration (e.g. about one hour after, about a day after, or about a week after JAKi administration), the subject's response/tolerance level of UVB light may be determined by transmitting various percentages of UVB light to the area of the subject's skin afflicted with the skin condition, using a dosimetry device, such as dosimetry device 200 of FIG. 2 (steps 320 and 330). Based on the response/tolerance level of UVB light, an optimal dose (optionally the maximal tolerated dose) of UVB light may be determined (step 340). According to some embodiments, the response/tolerance level of UVB light, and thus the optimal dose, may be affected by the administration of JAKi.

[0126] The optimal dose of UVB light determined in step 340 may then be applied to the subject (step 350).

[0127] Reference is now made to FIG. 4, which is a flowchart of a method 400 for localized treatment of a skin condition; according to some embodiments.

[0128] In step 410 of the method, a therapeutically effective amount of a JAKi is administered to the subject. According to some embodiments, the JAKi may be a JAK1 inhibitor. According to some embodiments, the JAKi may be a JAK2 inhibitor. 15. According to some embodiments, the JAKi may be selected from the group consisting of tofacitinib, ruxolitinib, oclacitinib, baricitinib, filgotinib, gandotinib, lestaurtinib, momelotinib, pacritinib, upadacitinib (ABT-494), peficitinib, cucurbitacin I, CHZ868, fedratinib, cerdulatinib, ATI-50001, Leo-124429, or a salt or solvate thereof. According to some embodiments, the JAKi may be tofacitinib, or a salt or solvate thereof. According to some embodiments, the JAKi administered to the subject in step 410, may be administered at a concentration of about 5-20 mg/day of tofacitinib. According to some embodiments, the JAKi may be ruxolitinib, or a salt or solvate thereof. According to some embodiments, the JAKi administered to the subject in step 410, may be administered at a concentration of about 5-50 mg/day of ruxolitinib.

[0129] Following administration (e.g. about one hour after, about a day after, or about a week after JAKi administration), the subject's response/tolerance level of UVB light may be determined by transmitting various percentages of UVB light to the area of the subject's skin afflicted with the skin condition, using a dosimetry device, such as dosimetry device 200 of FIG. 2 (steps 420 and 430). Based on the response/tolerance level of UVB light, an optimal dose (optionally the maximal tolerated dose) of UVB light may be determined (step 440). According to some embodiments, the response/tolerance level of UVB light, and thus the optimal dose, may be affected by the administration of JAKi. According to some embodiments, the optimal dose of UVB light determined may also affect the optimal dose of JAKi (which may need to be adjusted accordingly) as well as the regiment of the combined treatment (e.g. frequency of treatment, intensity of treatment, sequence of treatment, interval between treatments etc.). Accordingly, the method may include a step 440 of determining the optimal UVB light and/or JAKi treatment regimen based on the response of the treatment area to the varying percentages of UVB light and JAKi treatment. According to some embodiments, the method may further include a step 450 of providing treatment according to the determined optimal treatment regimen.

[0130] Reference is now made to FIG. 5, which is a flowchart of a method 500 for localized treatment of a skin condition; according to some embodiments.

[0131] Initially, the method of a subject's response/tolerance level to UVB light may be determined by transmitting various percentages of UVB light to an area of the subject's skin afflicted with the skin condition, using a dosimetry device, such as dosimetry device 200 of FIG. 2 (steps 510 and 520). Based on the response/tolerance level of UVB light, a maximal tolerated dose of UVB light may be determined (step 530). The optimal dose of JAKi may then be determined (step 540) according to the maximal tolerated dose of UVB light (steps 540). Without being bound by any theory, when only low levels of UVB light are tolerated, high doses of JAKi may be superfluous and a same effect may be achieved by lower doses of JAKi, thus reducing both cost and potential side effects of the treatment. Once, the optimal dose of JAKi is determined, the subject may be administered therewith (step 550) followed by a UVB treatment as set forth in step 560.

[0132] Reference is now made to FIG. 6, which is flowchart of a method 600 for localized treatment of a skin condition; according to some embodiments.

[0133] In step 610 of the method, a therapeutically effective amount of a JAKi is administered to the subject. According to some embodiments, the JAKi may be a JAK1 inhibitor. According to some embodiments, the JAKi may be a JAK2 inhibitor. 15. According to some embodiments, the JAKi may be selected from the group consisting of tofacitinib, ruxolitinib, oclacitinib, baricitinib, filgotinib, gandotinib, lestaurtinib, momelotinib, pacritinib, upadacitinib (ABT-494), peficitinib, cucurbitacin I, CHZ868, fedratinib, cerdulatinib, ATI-50001, Leo-124429, or a salt or solvate thereof. According to some embodiments, the JAKi may be tofacitinib, or a salt or solvate thereof. According to some embodiments, the JAKi, administered to the subject in step 610, may be administered at a concentration of about 5-20 mg/day of tofacitinib. According to some embodiments, the JAKi may be ruxolitinib, or a salt or solvate thereof. According to some embodiments, the JAKi, administered to the subject in step 610, may be administered at a concentration of about 5-50 mg/day of ruxolitinib.

[0134] Following administration (e.g. about one hour after, about a day after, or about a week after JAKi administration), the subject's response/tolerance level of UVB light may be determined by transmitting various percentages of UVB light to the area of the subject's skin afflicted with the skin condition, using a dosimetry device, such as dosimetry device 200 of FIG. 2 (steps 620 and 630). Based on the response/tolerance level of UVB light, an optimal dose (optionally the maximal tolerated dose) of UVB light may be determined (step 640 and 650). According to some embodiments, the response/tolerance level of UVB light and thus the optimal dose, may be affected by the administration of JAKi and vice versa. Accordingly, the method may include an additional step of reassessing the subject's response to different doses of UVB light using the dosimetry device, as described (step 660) and adjusting the dose of UVB light and/or JAKi administered based on the reassessment (step 670).

[0135] Reference is now made to FIG. 7, which is flowchart of a method 700 for localized treatment of a skin condition; according to some embodiments.

[0136] In step 710 of the method a therapeutically effective amount of at least two pharmaceutical agents is administered to the subject.

[0137] According to some embodiments, the at least two pharmaceutical agents comprise a biological drug, a systemic drug or a JAKi

[0138] According to some embodiments, the biological is selected from the group consisting of: alefacept, etanercept, adalimumab, infliximab, ustekinumab and any combination thereof. Each possibility is a separate embodiment.

[0139] According to some embodiments, the systemic drug is selected from the group consisting of: Methotrexate, Acitretin, Isotretinoin, Tegison, Cyclosporine, Apremilast, any pharmaceutically acceptable prodrug, metabolite, polymorph, salt, solvate (e.g., hydrate) or clathrate thereof and combinations thereof.

[0140] According to some embodiments, the JAKi is selected from the group consisting of tofacitinib, ruxolitinib, oclacitinib haricitinib, filgotinib, gandotinib, lestaurtinib, moinelotinib, pacritinib, upadacitinib (ABT-494), peficitinib, cucurbitacin 1, CHZ868, fedratinib, cerdulatinib, ATI-50001 Leo-124429, or a salt or solvate thereof. Each possibility is a separate embodiment.

[0141] Following administration (e.g. about one hour after, about a day after, or about a week after administration of the at least two pharmaceutical agents, the subject's response/tolerance level of UVB light may be determined by transmitting various percentages of UVB light to the area of the subject's skin afflicted with the skin condition, using a dosimetry device, such as dosimetry device 200 of FIG. 2 (steps 720 and 730). Based on the response/tolerance level of UVB light an optimal dose (optionally the maximal tolerated dose) of UVB light may be determined (step 740). According to some embodiments, the response/tolerance level of UVB light and thus the optimal dose, may be affected by the administration of the at least two pharmaceutical agents. Once the optimal dose has been determined in step 740, it may be optionally applied in step 750.

[0142] Reference is now made to FIG. 8, which is flowchart of a method 800 for localized treatment of a skin condition; according to some embodiments.

[0143] Initially, the method a subject's response/tolerance level to UVB light may be determined by transmitting various percentages of UVB light to an area of the subject's skin afflicted with the skin condition, using a dosimetry device, such as dosimetry device 200 of FIG. 2 (steps 810 and 820). Based on the response/tolerance level of UVB light a maximal tolerated dose of UVB light may be determined (step 830). The optimal dose of the at least two pharmaceutical agents may then be determined according to the maximal tolerated dose of UVB light (steps 840 and 850).

[0144] According to some embodiments, the at least two pharmaceutical agents comprise a biological drug, a systemic drug or a JAKi

[0145] According to some embodiments, the biological is selected from the group consisting of: alefacept, etanercept, adalimumab, infliximab, ustekinumab and any combination thereof. Each possibility is a separate embodiment.

[0146] According to some embodiments, the systemic drug is selected from the group consisting of: Methotrexate, Acitretin, Isotretinoin, Tegison, Cyclosporine, Apremilast, any pharmaceutically acceptable prodrug, metabolite, polymorph, salt, solvate (e.g., hydrate) or clathrate thereof and combinations thereof.

[0147] According to some embodiments, the JAKi is selected from the group consisting of tofacitinib, ruxolitinib, oclacitinib, baricitinib filgotinib, gandotinib, lestaurtinib, momelotinib, pacritinib, upadacitinib (ABT-494), cucurbitacin CHZ868, fedratinib, cerdulatinib, ATI-50001 Leo-124429, or a salt or solvate thereof. Each possibility is a separate embodiment.

[0148] Without being bound by any theory, when only low levels of UVB light are tolerated, higher doses of the at least two pharmaceutical agents may be needed to obtain an optimal effect. If, on the other hand, large doses of UVB are tolerated, a lower dose of the at least two pharmaceutical agents may potentially be required, thus reducing both cost and potential side effects of the treatment. Once, the optimal dose of the at least two pharmaceutical agents is determined, the subject may be administered therewith followed by a UVB treatment as set forth in step 860.

[0149] While a number of exemplary aspects and embodiments have been discussed above, those of skill in the art will recognize certain modifications, additions and sub-combinations thereof. It is therefore intended that the following appended claims and claims hereafter introduced be interpreted to include all such modifications, additions and sub-combinations as are within their true spirit and scope.