By Henry Ehrlich
Welcome back, Dr. Peter Lio, the Chicago dermatologist who has honored this website with a number of excellent pieces on atopic dermatitis, the maddening skin condition that while not life threatening by itself can reduce patients to uncontrollable scratching and despair. Like other allergic conditions, notably asthma, the go-to medicines are forms of corticosteroids—in topical form and when things get really bad systemic steroids. These drugs produce periods of relief followed by rebound episodes that can end up worse than before, and also mood disorders. Now Peter returns with a piece on what looks to be a breakthrough drug. Indeed, as he points out, it has bee designated such by the FDA. (We have written about the “breakthrough” designation previously.)
I have been anxious to get some coverage of this new monoclonal antibody ever since I sat through a talk by Dr. Emma Guttman-Yassky at the New York Asthma and Allergy Society where we were treated to a sumptuous roast chicken dinner while watching slides of skin being transformed from what looked like second-degree burns to peaches and cream. A miracle, long overdue.
By chance, as I was preparing Peter’s article for preparation, a post came up on my Twitter feed from Investor’s Business Daily with the headline “Regeneron Could Add $604 Million to 2018 Top Line on Eczema” the estimate by a stock analyst named Adna Butt. Let’s face it. Miracles often cost a lot of money.
Butt writes that in a survey of 51 U.S. dermatologists who treat an average 4,300 patients per month, a majority said they have a pool of patients who could benefit from the drug immediately. Butt also says, “A minority expect to prescribe dupilumab to pediatric patients ahead of approval by the U.S. Food and Drug Administration, which could provide another upside,” with an eventual market around 2-million, out of 5-million eczema patients altogether. Unless some of them are cured by the drug, or achieve what Dr. Lio calls “deep remission,” or at least deep discounts, this is going to be big-ticket item for insurance companies and taxpayers, let alone individuals. Even at prices comparable to Xolair, the monoclonal antibody used for asthma and chronic urticaria, which runs $10,000 per annum compared to $32,500 for the asthma drug Nucala—well, you do the arithmetic.
(For a different perspective on treating moderate-to-severe eczema, read chapter five of Traditional Chinese Medicine, Western Science, and the Fight Against Allergic Disease.)