Thought leaders discuss the importance of rapid onset of action in atopic dermatitis care amid the backdrop of compelling 4-year efficacy and safety data for dupilumab.
Andrew F. Alexis, MD, MPH: Thinking about some of the efficacy we looked at, we see that dupilumab demonstrated rapid improvements in AD [atopic dermatitis] signs and symptoms in the first few weeks. How important do you think rapid onset is when selecting a therapy for AD? This chronic disease is a marathon, not a sprint. Does it matter to you?
Benjamin N. Lockshin, MD: I appreciate your analogy about this being a marathon rather than sprint, but I liken it to a sprint that turns into a marathon.
Andrew F. Alexis, MD, MPH: Very well.
Benjamin N. Lockshin, MD: Many of our patients came in with built-in expectations. Any patients who had been given IM [intramuscular] Kenalog [triamcinolone] or oral steroids have expectations that things work quickly. Steroids have a quick onset of action, but obviously they come with a lot of baggage. What I like about dupilumab is that by the time patients are ready for that second shot, they’ve already noticed some change.
In terms of waypoints that I set for patients, I have 2 measures for expectations. The first waypoint is at 1 month, which is when you should start noticing an appreciable difference in itch, though it may happen much earlier. Your skin should have an appreciable change in about 3 months, though based on the data, there’s significant separation a lot earlier. Then I tell patients that if they make it to 52 weeks, it’s almost clear sailing. Patients appreciate that.
You had mentioned earlier that it’s frustrating or overwhelming for a patient to hear that they have a chronic disease and that they potentially need to be on these medications for the long haul. I position it by saying, “Let’s see how you’re doing in a year, and we’ll readdress our options.” That gives patients some buy-in and an opportunity to talk about how they want to chart their course moving forward.
Andrew F. Alexis, MD, MPH: That’s such a great pearl, and it’s an excellent example of shared decision-making. I like that: let’s reassess in 1 year and see where we are, which implies that the patient will weigh in on that decision. When it comes to the rapidity of response, that goes a long way for adherence as well. To your point, when a patient starts to feel itch reduction within days or within the first 2 weeks and see some reduction in some of the visible signs and physical symptoms of the disease in the initial period, that gives them a lot of confidence to keep going. That’s another upside with respect to seeing rapid improvements.
Transcript edited for clarity