By Henry Ehrlich
A “golden era for atopic dermatitis” is how Dr. Emma Guttman-Yassky of Mount Sinai describes the explosive growth of promising research for treatment of debilitating AD in Gwen Smith’s vivid and authoritative new cover article “Eczema’s Therapy Revolution” in the summer edition of Allergic Living. Dr. Guttman-Yassky’s work has held my attention raptly since I saw her present her work on the biologic dupilumab several years ago, complete with visuals tailor made for consumption while eating roast chicken, with “before” legs that looked like they had been pulled out of a burning building. Fortunately, the “after” pictures made up for them.
Apart from the two cases recounted, one of a lawyer and another of a professional harpist, whose lives were snatched back from pain, disfigurement, and despair, Gwen’s article does a wonderful job of elucidating the nature of collaboration between a committed scientist and a big pharmaceutical company called Regeneron, to the credit of both. Dupilumab—now marketed as Dupixent—targets two “chemical messengers,” IL-4 and IL-13, which play a role in many other allergic diseases, and in classic “off-label” fashion, the inhibition of these cytokines suggests a number of other uses for the drug, including severe asthma (phase-3 study in progress), nasal polyps (phase 2), and works-in-progress, food allergies and EoE.
As we have discussed previously, cost and duration of treatment remain are both factors. At a list price of $37,000 per year, you are at the mercy of your insurance company, although a Regeneron rep told me recently that insurers are receptive since the standard of care is so dismal for this class of patients—the case histories make that clear. And as the article suggests, this is a treatment, not a cure. Patients feel “normal” but as the time for another dose approaches “symptoms and itch begin to creep in.”