Most people with eczema find it intensely frustrating. They itch, and their skin is often red with swollen patches. Medications may help soothe the irritation, but most patients don’t know why they suffer. Moreover, they can’t find a cure. Could a drug called dupilumab (Dupixent) offer a solution?
Dupixent for Eczema:
Q. You recently wrote about the challenges of treating eczema (atopic dermatitis). You described a number of over-the-counter treatments as well as modern prescription medicines. In particular, you described serious side effects associated with Rinvoq, such as susceptibility to infections, cancer, heart attacks and strokes.
However, you did not mention another important medication, dupilumab. This drug offers significant benefit for patients with severe atopic dermatitis that hasn’t responded to comprehensive management. It does not cause the potentially significant side effects associated with Rinvoq.
Omitting Dupixent from your discussion implies that people with this debilitating disease don’t have options other than Rinvoq. I am basing my comments on published studies as well as my clinical experience treating patients with severe eczema. Please correct this oversight.
A. We do appreciate hearing from doctors who are treating patients. We assume you, like other dermatologists, begin treating eczema with strong moisturizers as well as corticosteroid creams. Topical immunosuppressing drugs, especially tacrolimus or pimecrolimus, might be the next step. You refer to people who have not responded to this kind of comprehensive management.
More on Dupilumab:
Dupilumab is a monoclonal antibody that blocks some important immune system signaling molecules (interleukin-4 and IL-13). In clinical trials submitted to the FDA, 35 to 50 percent of patients with moderate-to-severe atopic dermatitis got significant benefit. Forty to 60 percent had important reductions in itching. Those are significantly better than the placebo response.
Side effects of Dupixent include eye problems such as conjunctivitis, dry eye and itching eyes. People taking Dupixent are also more susceptible to herpes infections. They may also suffer muscle pain or joint pain, which can be severe. We trust that you and other doctors prescribing Dupixent review these possible responses with patients before they begin taking the medication. You are certainly correct that these adverse effects are less serious than those that may be triggered by Rinvoq or Cibinqo.
Another reader is puzzled about Dupixent commercials for two different indications.
Why Are There Such Different Ads for Dupixent?
Q. Lately I’ve been struck by two different TV commercials for Dupixent to treat asthma and eczema. Can you elaborate on how one medication could be advertised to treat these two completely different conditions?
A. Dupilumab (Dupixent) is a “biologic” injectable drug. The “mab” at the end of the generic name stands for “monoclonal antibody.”
The drug works by interfering with cytokines, natural immune system compounds that play a role in inflammation. Both asthma and eczema (atopic dermatitis) are the result of allergic inflammation. That is why you might see an ad like this about its role in treating asthma. On another channel, you could also watch this ad or a similar one for Dupixent used to ease eczema. We haven’t seen ads for its third indication, chronic rhinosinusitis (congestion and runny nose) with nasal polyps. As with all television commercials, you need to listen closely to the list of side effects associated with the medication.
The drug can trigger severe allergic reactions. It can also cause several serious eye problems. People taking Dupixent are also more susceptible to herpes infections (both cold sores and genital herpes). In addition, Dupixent can cause significant joint pain.
What About Dupixent for Nasal Polyps?
Q. When I first got Dupixent injections every two weeks for nasal polyps that had been surgically removed twice before, I thought it was a miracle. I was able to breathe, smell and swallow again. As a result, I gladly used drops for the eye pain it caused.
Unfortunately, after a year on the drug all the problems with my polyps started returning, while side effects multiplied. First pain in my knees made it difficult to walk. Then I got back pain so excruciating that I couldn’t even turn over in bed.
Since I got Dupixent for free because I couldn’t afford the high cost, I guess I shouldn’t complain. But I feel like I was sucked into a clinical trial without enough known about this drug before it was put out there on the market.
A. People inject themselves with Dupixent (dupilumab) to treat asthma, atopic dermatitis (eczema) and nasal swelling and polyps, as well as some other hard-to-treat conditions.
Side effects of Dupixent may include injection site reactions, conjunctivitis (eye irritation), joint pain, digestive distress, insomnia and toothache.
Antibodies to an Antibody:
Some people develop antibodies to this mab-type drug after several months. This immunological reaction can reduce its effectiveness and trigger other adverse events. Perhaps that is what has happened to you. Please discuss this possibility with your physician.
Will Dupixent Vanquish Long-Standing Eczema?
Q. Not too long ago, a reader asked about eczema, lamenting that there is no cure. I suffered from eczema for over four decades, but last year my dermatologist suggested that I try a new drug called Dupixent. Within a week, it had completely cleared my eczema, and I’ve had no recurrence since then.
On the downside, the list price of the drug is hideously high. (I pay nothing thanks to my medical insurance and a discount from the drug maker.) I give myself an injection every 14 days. Readers with eczema who have good medical coverage and who aren’t afraid of needles might want to ask their doctors about this option. It’s changed my life for the better.
Who Could Benefit from This New Drug?
A. Dupixent is a relatively recent treatment for atopic dermatitis. That’s the medical term for eczema, which may be an expression of an overactive immune system. The FDA approved this immune-modifying medication on March 28, 2017, for people whose condition has not responded to standard treatments. Specifically, although young children often have eczema, Dupixent is approved only for people older than 6. About half of the volunteers in the clinical trials on this drug found that it reduced their symptoms by at least 75 percent.
What Does It Cost?
You are right that the price is breathtaking. Someone without good insurance might have to pay over $3,000 a month. That’s for two injections.
Does Dupixent Have Side Effects?
A reader of our newspaper column shared this sad story:
Q. My husband must have been one of the first to take Dupixent for eczema when other prescriptions didn’t work. When his eyesight began to fail, the dermatologist assured him it couldn’t be the drug. He even spoke to the manufacturer, who said they had no reports of eye problems.
He saw several eye specialists and eventually was referred to a renowned retina specialist. That doctor determined Dupixent was the most likely cause of his eye problems and took him off of it.
Many months and several extremely expensive eye treatments have followed. He’ll have to continue them for at least two years.
It doesn’t amaze us that Dupixent commercials now mention possible eye problems! True, the drug removed 90 percent of the eczema, but it clearly wasn’t worth it.
A. Doctors call eye problems linked to dupilumab (Dupixent) DAOSD (dupilumab-associated ocular surface disease). The most common eye side effects are conjunctivitis and keratitis. There are also case reports of serious eye inflammation (Ocular Immunology and Inflammation, July, 2022).
Because this is a monoclonal antibody that suppresses the immune system, some patients have developed herpes infections in their eyes (Acta Dermato-Venereologica, April 1, 2019). The authors recommend that dermatologists collaborate with ophthalmologists when prescribing this drug for severe eczema.
Other complications of immune system inhibition may include cold sores or other herpes infections. In addition, some people using this injectable medicine eventually develop antibodies to it and cannot continue to utilize it.