People who have an allergic parent are pretty likely also to be allergic. But those of us with two allergic parents (yours truly) are really hosed. We are much more liable to have atopic dermatitis, (aka AD, eczema) (1) and that isn't much fun.
The name is a bit misleading (2) because atopy is not just itchy skin. Atopics are genetically predisposed (3) to also suffer from allergic rhinitis (hay fever, allergies to animals,) have allergies to certain foods and asthma. When these three occur together (which is not uncommon) is it called an "atopic triad." I can personally tell you that it just plain sucks.
Until now, standard treatments for severe eczema have been topical steroids and UV light therapy. Each carries its own risk, and neither prevents a subsequent flare-up. Now there is another choice, and it could be a game changer—The FDA just approved Regeneron/Sanofi's Dupixent (dupilumab), an antibody that treats moderate-to-severe atopic dermatitis. And it does so in an entirely different way—by modifying the defective components of our immune system that are responsible for the hyperimmune response.
Dupixent acts by inhibiting two cytokines that are responsible for the hyperimmune response in skin. They are called IL-4 and IL-13. IL is an abbreviation for interleukins, proteins that are produced by leukocytes (3) and play a part in regulation of the immune system. Steroids, such as prednisone, also suppress the immune system, but taking them for an extended period of time will get you into trouble. (See: Prednisone: Satan's Little Helper) Unlike prednisone, Dupixent inhibits specific targets. It works more like a scalpel than a bomb.
And it's badly needed. Those afflicted from severe AD suffer badly. So much so that people who have have a significantly higher risk of suicide.
AD sufferers have good reason to be optimistic. The stuff works very well. In Phase III studies:
- After 16 weeks about 37 percent of severe AD patients who got the drug (an injection) every two weeks had complete or nearly-complete clearance compared to placebo (about nine percent).
- Another 50 percent showed a significant response, as determined by the Eczema Area and Severity Index (4)
- Patients who received the drug also reported less itching, anxiety, and depression
As is the case with any new biologic, Dupixent will be expensive, but not as bad as most others. Regeneron/Sanofi have set the price at $37,000 per year (5), and will offer patient assistance. People who love to complain about high drug prices will do just that, but I expect that people with severe eczema won't be complaining all that much. More likely, they will be grateful.
Notes:
(1) The terms eczema and atopic dermatitis are often used interchangeably. Atopic dermatitis is a subset (the most common) form of eczema.
(2) The term "atopic" is derived from the Greek word atopos. The "a" means uncommon. Topos means place. This means that the dermatitis comes from another place than the skin—the immune system. Atopic is now defined as a hereditary allergy caused by the overreaction one or more components of the immune system being exposed to an antigen.
(3) Leukocytes are a type of white blood cell. Their function is to protect the body from foreign pathogens
(4) The Eczema Area and Severity Index is one of the ways of determining how severe the eczema is and how much of the body is involved.
(5) There will be additional savings for patients. The drug comes preloaded in syringes. No need for regular doctor appointments.
Josh Bloom
Director of Chemical and Pharmaceutical Science
Dr. Josh Bloom, the Director of Chemical and Pharmaceutical Science, comes from the world of drug discovery, where he did research for more than 20 years. He holds a Ph.D. in chemistry.
