As the only biologic on the market, dupilumab has replaced most of the more traditional treatments for atopic dermatitis, said David Pariser, MD, senior physician at Pariser Dermatology Specialists.
As the only biologic on the market, dupilumab has replaced most of the more traditional treatments for atopic dermatitis, said David Pariser, MD, senior physician at Pariser Dermatology Specialists and professor at Eastern Virginia Medical School Department of Dermatology.
What do you look at when deciding to treat with the biologic compared with one of the more traditional treatment options?
Well, I do have to say now that in most people's treatment paradigm, dupilumab, the currently available biologic, has really replaced the prescription of the more traditional methotrexate, cyclosporin, mycophenolate mofetil, which work well but have a lot more side effects than dupilumab.
Methotrexate, for example, has 11 warnings in its black box safety. Dupilumab has no black box. Cyclosporin is a drug that many physicians are just not familiar with the utilization of it. And dupilumab is a medication which requires basically no laboratory follow up and which has an extremely safe safety profile, has replaced those other more traditional immunosuppressants in most people's treatment armamentarium.
How will the Janus kinase inhibitors differ from biologics?
So, the Janus kinase inhibitors, of which there are 3 at least in study now for atopic dermatitis—2 of which will be available next year—work by a completely different mechanism. They're also oral drugs which are administered and that will make a difference for some patients and prescribers, having oral therapy as opposed to an injectable one.
A big issue with the Janus kinase inhibitors, including some which are on the market now for other diseases, is that they all have black box warnings. And they all will have safety issues, which dupilumab and tralokinumab, which will be on the market at that time, will not have. So, it will be a safety versus efficacy trade off, an oral drug versus checkable drug trade off. And then of course, there's always going to be the cost and the access and what hurdles will there be in prescription?