Dupixent (dupilumab) ushered in a new era and an increasing number of treatment options raised awareness of the disease. But panelists also discussed problems with step therapy, treatment delays and denials, and the lack of a ‘gold standard’ test for diagnosis.
Newly approved drugs. A group of others are waiting in the wings who are in late-stage clinical trials. Peter Lio, MD, says clinicians and patients are now in a shining chapter in the history of atopic dermatitis treatment.
“The biggest difference is just awareness,” said Lio, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine and founding director of the Chicago Integrative Eczema Center. “It’s one of the unintended consequences of[pharmaceutical]companies actually focusing on it. People are talking about it. They’re getting ready to get better for the first time. They’re coming back to our clinic. I’ve met people who said, “The last time I saw a dermatologist was in the 90s.” They just felt like there was nothing new to offer.
Lio was one of the speakers yesterday at an atopic dermatitis symposium at the Academy of Managed Care Pharmacy’s four-day AMCP 2022 meeting in Chicago.
Atopic dermatitis (AD) is the most common type of eczema and can overlap with other types of eczema. Sometimes atopic dermatitis and eczema are used interchangeably.
In a brief interview after his presentation, Lio also touched on some of the issues that clinicians and patients face, with step therapy being one of the main ones.
“The idea is logical and reasonable. You don’t want people to start taking a super potent drug,” Lio said. complex, the more serious they are, the worse it is.”
He gave as an example the requirement that some insurers have treatment with Eucrisa (crisaborole), an ointment, tried first and found to be ineffective before other treatments are covered.
“It’s not even indicated for severe patients,” Lio said. “That does not make any sense.”
Another speaker at the symposium, Neil Minkoff, MD, chief medical officer of Coeus HealthCare, shared the results of a survey of patients with atopic dermatitis which showed that 50% had experienced a delay or refusal of a prescription during of the last 12 months. The survey showed that half of refusals were due to step therapy and 60% of delays due to prior authorization.
Lio, who specializes in patients with severe atopic dermatitis, credited Dupixent (dupilumab), an injectable biologic drug approved in 2017, with ushering in a new era of atopic dermatitis treatment.
“It’s changed everything and allows us to offer long-lasting control to a large group of people who’ve never had it before, in a really safe way,” he said. Lio also mentioned Rinvoq (upadacitinib) and Cibinquo (abrocitinib), oral treatments in JAK inhibitors, as stoking optimism.
Still, there are people for whom Dupixent isn’t effective or has serious side effects, Lio said, and therefore the need for more treatment options. He mentioned five agents in late-stage clinical development: lebrikizumab, nemolizumab, baricitinib, delgocitinib and difamilast.
Lio said there was also a need for treatments other than the “big guns” for severe cases, as many people with atopic dermatitis have milder cases. “We need better things at the lower level,” he said.
Another panelist, Michael Zeglinski, Executive Vice President and CEO of Optum Specialty and Infusion Pharmacies, shared data showing that 42% of patients with atopic dermatitis have outlays of $1,000 or more and 8.5 % reported costs over $5,000. Zeglinski noted that patients face the cost by not starting treatment or taking treatment breaks to spread the cost. He said co-pay assistance can offset out-of-pocket expenses, but added that accumulation programs, which prevent the value of co-pay assistance from counting toward an insurance policy’s deductible, have complicated the situation with co-payment assistance.
Zeglinski also mentioned the lack of a “gold standard” test to diagnose atopic dermatitis and the absence of biomarkers. These gaps make it difficult to track people’s response to treatment.
Minkoff argued for consideration of how atopic dermatitis affects sleep, mood, social life and other aspects of people’s lives, using a hypothetical college student as an example. As with many chronic conditions, he said it was important to set realistic treatment goals; for example, reducing the number of flares from three per year to one rather than creating hopes of getting rid of them altogether.
Michele Guadalupe, MPH, associate director of advocacy and access at the National Eczema Foundation, also participated in the symposium. She described the foundation’s role in raising awareness of atopic dermatitis and its efforts to improve treatment with tools that help patients record their symptoms.