Recently, the FDA approved the first ever injectable medication for moderate-to-severe atopic dermatitis (chronic eczema in the setting of hypersensitivity/sensitive skin). Patients and health care providers have been waiting for this breakthrough for a long time. However, this novel therapy may be confronted with some challenges that keep it from being able to reach the patients who are in need of this therapy.
What is Dupixent?
Dupixent ( dupilumab) is a biologic medication injected into the body created by pharmaceutical companies Regeneron and Sanofi. It is an IL-4/IL-13 inhibitor that blocks these parts of the inflammatory pathways that appears critical to causing the destructive inflammatory process of chronic eczema. The medication is given as two injections ( 600 mg) on Day 1 and then one injection ( 300 mg) on Day 15 and every two weeks afterwards.
What are the side effects of Dupixent?
Through inhibiting certain molecules of the immune system, Dupixent has a potential to cause immunosuppression. The studies showed that patients had the following most common adverse events: conjunctivitis, keratitis, blepharitis (all related to inflammation vs infection of the eyes and eyelids), oral herpes virus outbreaks vs recurrent infections.
One should also:
1. Avoid receiving live vaccines while on this treatment.
2. Be aware that Dupixent could potentially interact with medications that are CYP450 substrates ( cleared through a specific liver enzyme), such as oral cyclosporine and warfarin.
The Pros of Dupixent:
1. A novel therapy that targets inflammation associated with moderate-to-severe atopic dermatitis.
2. A non-steroid treatment that should not have the topical and systemic side effects of corticosteroids, which can negatively impact those with atopic dermatitis being treated with these medications.
3. A systemic drug that does not require daily application. Injections are administered every two weeks following the two-injection loading dose. This may be convenient and ideal for certain patients.
The Cons of Dupixent:
1. This drug was not studied in children, a population most commonly suffering with atopic dermatitis. It is FDA-Approved for individuals 18 years old and older.
2. It comes with a $37,000 a year price tag. This may impact its adoptablility and affordability.
3. An injectable drug that may pose systemic side effects related to immunosuppression and the formation of antibodies ( immunogenicity) to the medication over time.
What will happen next?
We are learning more about how we can get this treatment to patients in need who suffer from refractory or generalized eczema. It will be interesting to see how the makers of this drug handle insurers' willingness to cover or not cover this expensive therapy for an incurable, chronic disease. Patients will have to be very proactive to determine whether Dupixent will be a beneficial and affordable therapy or one available to only certain patients and covered by only certain insurers.
Talk to your health care provider if you suffer form hard-to-treat eczema, especially disease localized to multiple areas or throughout the body associated with asthma and/or seasonal allergies. We will tune in to see how insurers react to this medication's approval and its expensive price to determine whether its potential to improve quality of life and reduce health care charges related to refractory or worsening eczema is realistic
Margareth Pierre-Louis, MD, MBA