Practical Management of Atopic Dermatitis: Nurse Practitioner and Physician Assistant Perspectives - Episode 7

Dupilumab for Atopic Dermatitis

August 14, 2021
Melodie Young, MSN, RN, ANP-C, Mindful Dermatology and Modern Research Associates

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Douglas DiRuggiero, DMSc, PA-C, Skin Cancer and Cosmetic Dermatology Center

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Keri Holyoak, PA-C, MPH, Dermatology Center of Salt Lake

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Susan Tofte, DNP, MS, FNP-C, Oregon Health & Science University

Keri Holyoak, PA-C, MPH, reacts to the FDA approval of dupilumab for atopic dermatitis and explains what makes this therapy unique compared to other treatment options.

Melodie Young, MSN, RN, ANP-C [Mindful Dermatology and Modern Research Associates Dallas, Texas]: Because of the difficulties and the complexities of covering so much body surface area with topical therapies, we start looking for systemic options and a pill or a shot. Keri, I know that you have used a fair amount of dupilumab, and Susan, [Susan Tofte, DNP, MS, FNP-C, Oregon Health & Science University, Portland, Oregon] in her clinical trial work and at our center in Dallas, has helped to develop dupilumab as far as the relief and utilization of it. Can you speak to it a little more and teach us about dupilumab and when it's appropriate to use and how to use it?

Keri Holyoak, PA-C, MPH [Dermatology Center of Salt Lake, Midvale, Utah]: Dupilumab is an option. It's a biologic and taken as an injection. It targets the overactive immune system, specifically IL-4 (interlukin-4) and IL-13 (interlukin-13). It decreases the symptoms of atopic dermatitis but does not suppress the immune system. I'm really hesitant in using these immunosuppressant agents, and I'm grateful that we have better options available now with more on the horizon. If you suppress the immune system, you slow down the inflammation, but there's always this continuous inflammation. Dupilumab is a continuous, ongoing therapy. It was approved by the FDA 4 years ago in 2017, first for the treatment of adults for moderate-to-severe atopic dermatitis, and for those patients whose disease was not adequately controlled with topical therapies or when topical therapies weren't advisable. It was the first biologic, and it's been a game changer for those patients in my practice. There's no routine lab monitoring. As I mentioned, it started out indicated for those 18 years and older, but now it's approved down to the age of 6 years and older. I know it's being studied in patients down to 2 years and older. With my experience with this drug, I suspect that there may be a disease-modifying aspect to this medication.

Melodie Young, MSN, RN, ANP-C: It first came out for adults, and now it's been FDA-approved down to age 6. Is it a difficult time to access these drugs or to convince patients to use injectable medications, particularly in a child?

Keri Holyoak, PA-C, MPH: Sure. It is an expensive drug, so there are hurdles. It does require prior authorizations, but I think it really comes down to the education, and we're getting this drug covered, making it easier now since it's been on the market for over 4 years. It's worth the fight and I'm happy to do it, but when you talk about injections, it really goes back to education. You have got to educate the family, and it takes time. It's not an easy process; it's not an easy disease state. If we do a good job outlining to the families what they need to do, then we can see much better outcomes. We just have to get everyone on board; We need an alliance. When young patients who were first hesitant see the changes, they see the improvement of their life, they are less likely to complain about the injections. It's more of a "Don't take me off this medication. You know, this medication really works, and I want to stay on it."

Melodie Young, MSN, RN, ANP-C: Thank you for watching this HCPLive® Peer Exchange. If you enjoyed the content, please subscribe to our e-newsletters to receive upcoming peer exchange segments and other great content right in your in-box.

Transcript Edited for Clarity

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