Dupixenet treatment for atopic dermatitis
Atopic dermatitis is getting its own biologic: Dupilumab (Dupixenet), an injection that impacts the immune dysfunction that drives atopic dermatitis. It will be a game changer just as others have been for arthritis, psoriasis etc. Insurance companies are deciding how, or if, they will pay for it (estimated at $37,000 wholesale cost/year/patient). Physicians are lining up to learn how to safely prescribe it and monitor side effects . And, you’ll be hearing about it.
As with all the new biologics, there are side effects. Some are serious such as overwhelming infections and low white blood cells. But in general, all treatments for severe atopic dermatitis are risky including steroids and medicines known as calcineurin inhibitors (tacrolimus and pimecrolimus). They have side effects (like the theoretical risk of lymphomas) and black box warning that make everyone anxious. Calcineurin inhibitors are also expensive and insurance companies are reluctant to cover them as well.
Atopic dermatitis can be severe and impact your lifestyle
For severe atopic eczema patients, there have been no good options for treatment. If hydrating skin care, bleach baths, and avoidance of all allergens don’t help, then the disease runs a devastating and life-altering course. This lifestyle is filled with a whole body itch and weepy rash that gets infected continuously, the constant need for antibiotics, and a devotion to slathering on greasy creams.
Life inside of eczema skin is unimaginable to those without this vexing disease. Desperate patients and their physicians have turned to immunosuppressant drugs such as cyclosporin, methotrexate, and azazthioprin. These are serious drugs for a serious skin disease. Eczema can lead to severe depression. Atopic dermatitis is getting its turn with the new pharma attention and it's welcome. It will be expensive and lessons will be learned, but it is progress for those suffering from the life altering 'atopic derm'.
Eucrisa for treatment of atopic dermatitisThere is a new FDA-approved drug called crisaborole (Eucrisa). This medicine is a topical ointment that also intercedes in the immune cascade. It provided some relief in patients with less severe disease. There were “no serious adverse events” with stinging as the application site being the main side effect. According to a leader in the field of pediatric dermatology, Dr. Amy Paller:
crisaborole should fill the niche that steroids and calcineurin inhibitors currently leave open resulting from fears — justified or otherwise — over side effects.Paller went on to say:
I don’t think crisaborole is going to be more effective than topical steroids and the calcineurin inhibitors, but it is going to make many more people feel comfortable with using a prescription medication for atopic dermatitis, and that can make a big difference.
What’s the bottom line for treatment of atopic dermatitis?
I tell all my patients with atopic dermatitis to first start with good skin care and avoidance of topical allergens in all hygiene products (fragrances, notorious contact allergen preservatives, even natural botanical essential oils etc).
My goal is to offer a range of hypoallergenic products, because I see so many patients with eczema - mild to severe. I know what they go through, and the little triggers that prompt into big suffering. Click here to see hypoallergenic products for a range of needs.
Milder atopics tolerate many of these products, but some of these products are not appropriate for severe types. Hydrate your skin constantly because good skin barrier integrity helps to prevent some of the atopic cascade that leads to eczema. Ask your pediatrician and/or dermatologist for help early and often to keep eczema from spiraling out of control. If and when it does, ask about these new treatment options.
Atopic dermatitis: dupilumab and crisaborole could herald a new era in treatment, The Pharmaceutical Journal, 23 Feb 2017
Regeneron’s New Drug Price Could Disappoint Everyone. Here’s Why That’s A Good Thing, Forbes, Pharma & Healthcare, Mar 28, 2017