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    Fitting in

    Experts expect dupilumab to play important role in AD treatment

    The approval of dupilumab (Dupixent, Sanofi Regeneron) for moderate-to-severe atopic dermatitis adds a much-needed option that may alter the broader course of atopic disease, experts told Dermatology Times. As with any biologic drug, they add, dermatologists likely will need to advocate for insurance coverage.

    Blazing new trails

    Dr. Blauvelt“The FDA approval of dupilumab fulfills an unmet need for dermatologists who care for patients with more severe eczema. These patients have been suffering, with very few good options available for many years. This is going to be a trailblazer for practitioners who are trying to manage these difficult patients,” said Andrew Blauvelt, M.D., M.B.A., president of the Oregon Medical Research Center. He was principal investigator on the phase 3 Randomized, Double-Blind, Placebo-Controlled Study to Demonstrate the Efficacy and Long-Term Safety of Dupilumab in Adult Patients with Moderate-to-Severe Atopic Dermatitis (CHRONOS; for more information on these data, please see story, page 42).

    “For patients,” said Emma Guttman-Yassky, M.D., Ph.D., “it’s amazing. We now have moderate-to-severe patients who were treated by community dermatologists, allergists or other physicians for many years — with only topical or oral steroids, phototherapy or other systemics such as the immune suppressant cyclosporine — and nothing worked. ... They Dr. Guttman-Yasskyfinally have a treatment that is safe” for long-term use. She is professor and vice chair, department of dermatology, Icahn School of Medicine at Mount Sinai.

    Lawrence F. Eichenfield, M.D., adds, “Dupilumab is the first biologic agent developed, and approved, for atopic
    dermatitis. Our more severe atopic dermatitis patients are miserably impacted by their disease, and the promise of successful biologic therapy is a life-changer. There is real excitement — among dermatologists, patients and their families.”

    He is chief of pediatric and adolescent dermatology, professor of dermatology and pediatrics and vice chair, department of dermatology, at the University of California, San Diego School of Medicine.

    Treating moderate-to-severe AD has long been challenging, Dr. Blauvelt says, because therapy for more severe disease has involved broadly acting immunosuppressants that bring numerous difficulties and side effects with long-term use.

    Eric L. Simpson, M.D., M.C.R., explains, “Because of a lack of good options, dermatologists often prescribe systemic steroids for adults with moderate to severe atopic dermatitis,” a practice that all treatment guidelines discourage.

    “Dupilumab provides a novel option that is targeted, thus minimizing side effects that are encountered with less specific systemic therapies such as systemic steroids and other traditional immunosuppressants.”

    Mechanism of action

    Dr. PallerDupilumab blocks the interleukin 4 (IL-4) receptor alpha subunit (IL-4Rα), which blocks signaling of both IL-4 and IL-13, 2 cytokines required for the T helper cell 2 (Th2) response. Dr. Simpson is professor and director of clinical trials in the Oregon Health Sciences University department of dermatology.

    Thanks to dupilumab, Amy Paller, M.D., says, “Many of our patients will be able to transition off of immunosuppressants that they’ve been on for a long time. Despite long-term use of systemic medications, the AD for many patients is only partially controlled, and frequent laboratory testing is required to test for toxicity. It’s going to be a godsend for many people.”

    She is chair, department of dermatology; director, Northwestern University Skin Disease Research Center (SDRC); and professor in of pediatrics at Northwestern University.

    Next: Halting atopic march

    John Jesitus
    John Jesitus is a medical writer based in Westminster, CO.

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