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Most people with eczema find it intensely frustrating. They itch, and their skin is often red with swollen patches. Medications may help soothe the irritation, but most patients don’t know why they suffer. Moreover, they can’t find a cure. Could a drug called dupilumab (Dupixent) offer a solution?
Dupixent for Eczema:
Q. You recently wrote about the challenges of treating eczema (atopic dermatitis). You described a number of over-the-counter treatments as well as modern prescription medicines. In particular, you described serious side effects associated with Rinvoq, such as susceptibility to infections, cancer, heart attacks and strokes.
However, you did not mention another important medication, dupilumab. This drug offers significant benefit for patients with severe atopic dermatitis that hasn’t responded to comprehensive management. It does not cause the potentially significant side effects associated with Rinvoq.
Omitting Dupixent from your discussion implies that people with this debilitating disease don’t have options other than Rinvoq. I am basing my comments on published studies as well as my clinical experience treating patients with severe eczema. Please correct this oversight.
A. We do appreciate hearing from doctors who are treating patients. We assume you, like other dermatologists, begin treating eczema with strong moisturizers as well as corticosteroid creams. Topical immunosuppressing drugs, especially tacrolimus or pimecrolimus, might be the next step. You refer to people who have not responded to this kind of comprehensive management.
More on Dupilumab:
Dupilumab is a monoclonal antibody that blocks some important immune system signaling molecules (interleukin-4 and IL-13). In clinical trials submitted to the FDA, 35 to 50 percent of patients with moderate-to-severe atopic dermatitis got significant benefit. Forty to 60 percent had important reductions in itching. Those are significantly better than the placebo response.
Side effects of Dupixent include eye problems such as conjunctivitis, dry eye and itching eyes. People taking Dupixent are also more susceptible to herpes infections. They may also suffer muscle pain or joint pain, which can be severe. We trust that you and other doctors prescribing Dupixent review these possible responses with patients before they begin taking the medication. You are certainly correct that these adverse effects are less serious than those that may be triggered by Rinvoq or Cibinqo.
Another reader is puzzled about Dupixent commercials for two different indications.
Why Are There Such Different Ads for Dupixent?
Q. Lately I’ve been struck by two different TV commercials for Dupixent to treat asthma and eczema. Can you elaborate on how one medication could be advertised to treat these two completely different conditions?
A. Dupilumab (Dupixent) is a “biologic” injectable drug. The “mab” at the end of the generic name stands for “monoclonal antibody.”
The drug works by interfering with cytokines, natural immune system compounds that play a role in inflammation. Both asthma and eczema (atopic dermatitis) are the result of allergic inflammation. That is why you might see an ad like this about its role in treating asthma. On another channel, you could also watch this ad or a similar one for Dupixent used to ease eczema. We haven’t seen ads for its third indication, chronic rhinosinusitis (congestion and runny nose) with nasal polyps. As with all television commercials, you need to listen closely to the list of side effects associated with the medication.
The drug can trigger severe allergic reactions. It can also cause several serious eye problems. People taking Dupixent are also more susceptible to herpes infections (both cold sores and genital herpes). In addition, Dupixent can cause significant joint pain.
What About Dupixent for Nasal Polyps?
Q. When I first got Dupixent injections every two weeks for nasal polyps that had been surgically removed twice before, I thought it was a miracle. I was able to breathe, smell and swallow again. As a result, I gladly used drops for the eye pain it caused.
Unfortunately, after a year on the drug all the problems with my polyps started returning, while side effects multiplied. First pain in my knees made it difficult to walk. Then I got back pain so excruciating that I couldn’t even turn over in bed.
Since I got Dupixent for free because I couldn’t afford the high cost, I guess I shouldn’t complain. But I feel like I was sucked into a clinical trial without enough known about this drug before it was put out there on the market.
A. People inject themselves with Dupixent (dupilumab) to treat asthma, atopic dermatitis (eczema) and nasal swelling and polyps, as well as some other hard-to-treat conditions.
Side effects of Dupixent may include injection site reactions, conjunctivitis (eye irritation), joint pain, digestive distress, insomnia and toothache.
Antibodies to an Antibody:
Some people develop antibodies to this mab-type drug after several months. This immunological reaction can reduce its effectiveness and trigger other adverse events. Perhaps that is what has happened to you. Please discuss this possibility with your physician.
Will Dupixent Vanquish Long-Standing Eczema?
Q. Not too long ago, a reader asked about eczema, lamenting that there is no cure. I suffered from eczema for over four decades, but last year my dermatologist suggested that I try a new drug called Dupixent. Within a week, it had completely cleared my eczema, and I’ve had no recurrence since then.
On the downside, the list price of the drug is hideously high. (I pay nothing thanks to my medical insurance and a discount from the drug maker.) I give myself an injection every 14 days. Readers with eczema who have good medical coverage and who aren’t afraid of needles might want to ask their doctors about this option. It’s changed my life for the better.
Who Could Benefit from This New Drug?
A. Dupixent is a relatively recent treatment for atopic dermatitis. That’s the medical term for eczema, which may be an expression of an overactive immune system. The FDA approved this immune-modifying medication on March 28, 2017, for people whose condition has not responded to standard treatments. Specifically, although young children often have eczema, Dupixent is approved only for people older than 6. About half of the volunteers in the clinical trials on this drug found that it reduced their symptoms by at least 75 percent.
What Does It Cost?
You are right that the price is breathtaking. Someone without good insurance might have to pay over $3,000 a month. That’s for two injections.
Does Dupixent Have Side Effects?
A reader of our newspaper column shared this sad story:
Q. My husband must have been one of the first to take Dupixent for eczema when other prescriptions didn’t work. When his eyesight began to fail, the dermatologist assured him it couldn’t be the drug. He even spoke to the manufacturer, who said they had no reports of eye problems.
He saw several eye specialists and eventually was referred to a renowned retina specialist. That doctor determined Dupixent was the most likely cause of his eye problems and took him off of it.
Many months and several extremely expensive eye treatments have followed. He’ll have to continue them for at least two years.
It doesn’t amaze us that Dupixent commercials now mention possible eye problems! True, the drug removed 90 percent of the eczema, but it clearly wasn’t worth it.
A. Doctors call eye problems linked to dupilumab (Dupixent) DAOSD (dupilumab-associated ocular surface disease). The most common eye side effects are conjunctivitis and keratitis. There are also case reports of serious eye inflammation (Ocular Immunology and Inflammation, July, 2022).
Because this is a monoclonal antibody that suppresses the immune system, some patients have developed herpes infections in their eyes (Acta Dermato-Venereologica, April 1, 2019). The authors recommend that dermatologists collaborate with ophthalmologists when prescribing this drug for severe eczema.
Other complications of immune system inhibition may include cold sores or other herpes infections. In addition, some people using this injectable medicine eventually develop antibodies to it and cannot continue to utilize it.
Mary
My dermatologist put me on Dupixent when I complained of terrible itching from seborrheic keratosis and possibly immunotherapy treatments for cancer. The itching has subsided but my joint pain has been so debilitating that my life has changed dramatically. I had 2 injections 2 weeks apart when the pain set in and now, almost 2 months after stopping injections, I cannot get up from a chair without excruciating pain. My knees are swollen to twice their normal size. My feet and lower legs are also swollen. My hands are so painful when I awake in the morning that I can hardly pick up a toothpick without excruciating pain. I’m praying this drug exits my system soon. Joint pain is listed as a side effect that can be so severe that it may require hospitalization. I’ll live with the itching problem I was experiencing rather than ever take this drug again.
Judith
After reading this and the comments, I was compelled to write a comment in favor of Dupixent, as it completely turned my life around, following 2 years of misery, looking and feeling like a burn victim. I had tried everything that anyone recommended, with no relief. My dermatologist finally allergy tested me and found an allergy to MCI & MIT. It is in many cosmetics/ hair products and household cleaning products. Dishwashing detergent triggered my eczema, which worsened regardless of avoidance to allergens. I even had to stop eating foods which contain nickel, because some folks cannot tolerate these foods if they are allergic to nickel in metals, like jewelry, etc. It is in many foods and difficult to avoid. I now have to avoid the healthy foods I used to enjoy frequently, and even stainless steel cookware.
Dupixent has allowed me to live a normal life for four years; however, I began to think about the past 2 weeks. I have had severe pain in my knees for 6 months, and finally got relief this week, after physical therapy, work on sitting posture and use of a footstool and sturdy shoes. Now it occurs to me that I had a mishap with my autoinjector 2 weeks ago, and it appeared that most of the medication was not injected. Could that be the reason for my pain disappearing??? It is time for another dose, but I will see if I can experiment with this and rule out the medication as a cause. Thank you for always pointing out the possibilities.
Now, I wonder what you can tell us about Opzelura, as it has worked wonders for my facial eczema that has become a struggle, regardless of using Dupixent.
Lawrence
According to my parents I had horrible eczema as a baby. At about 6 months, I grew out of it. In my early 20s I developed hand eczema which I have had my entire life. A few years ago eczema returned on much of my body. I was pretty miserable for awhile. I tried all the natural creams I saw recommended. Nothing helped. A combination of hydrocortisone cream and prescription tacrolimus ointment managed the condition but I always worried about Topical Steroid Withdrawal (TSW) and side effects. Then I came across a recommendation to try bovine immunoglobulins, related to colostrum that mother’s milk provides. Three months later my hand eczema is completely clear, and eczema on my body is limited to two small spots. No more steroid creams, ointments, or moisturizers. At least so far, immunoglobulins along with probiotics, have been the miracle cure I was hoping to find.
Shirley
In the side-effect section you forgot to mention the heart attack some people might have when they hear what this drug will cost….as much as an apartment’s rent!
Paulis
What amazes me is how little doctors seem to study medication side effects. I am a very asthmatic person and also have nasal polyps. I’m also blind in my right eye after several episodes of central serous retinopathy. I have cataracts in the other eye (steroids). Both my allergist and ENT have suggested this new drug to me. I asked about side effects, specifically eye, which I always check, and they basically shrugged. I did my own research and pointed out the evidence on eye complications. Not all are reversible either. Again they each shrugged and said they haven’t personally seen any issues. What about medical literature?! Clearly a 70 year-old person with only one good eye is not the best candidate to take on this risk.
This is why I always do my research and why I try to avoid drugs that are relatively new. But it’s disturbing. The same allergist prescribed a new drug that contained anti-cholinergics (associated with Alzheimer’s) to my 73 year-old husband in spite of his strong family history of dementia (she never asked) and his being in an age group that is supposed to avoid them. I did my own research, and he went with a different medication.
Thank you, peoples pharmacy, for the education I’ve gotten from you over the years. It’s very helpful.
Liz
I have severe allergies and developed allergy-related eczema after treating them so much. My allergist (and immunologist in one) suggested Dupixent, but I was worried about the side effects and cost. But the sife effects are rare and generally less severe than with other medications, and my allergist’s nurse mentioned the “My Dupixent” copay card. I figured, the worst it can do is not work, so I went for it — and I’m glad I did!
Through “My Dupixent,” I pay nothing for this wonderful drug. At first I had to inject myself with a syringe, but after suffering through that for a few months, my allergist switched me to the pen injector version — same thing, just in the form of a pen (similar to EpiPen). No problems since, and I’ve now been on it for 3 years. Because my case is so severe, I do still have some very minor and manageable patches of eczema, but most patients don’t have to worry about that. I’ve also had no side effects, which is pretty unusual for me.
If you’re on the fence about Dupixent for any reason, please speak about that with your physician! They and their staff can help you figure out the cost and benefits of giving it a go.
David
One of the things that I found cause eczema is food allergies. Doing a simple blood test and avoiding those foods that cause allergies many times will cause a reversal in the rash. This isn’t always true but in many cases an avoidance diet does make the difference. (Asthma and allergic rhinitis can also be caused by food and/or pollen allergies).
Lynne
My first comment after reading all the newsletters faithfully is that I’m going to have nasal polyp surgery. My allergist is keen on me starting dupixent afterwards to keep inflammation down. I’m eager for any information on people who need the drug for that purpose. I’m fearful of the side effects, especially the eye stuff.
Mike
I have had mild episodes of atopic dermatis on and off for most of my life, but about three years ago it exploded; I looked like a leper and wore long sleeves and long pants on the hottest days of summer so as not to scare children (“Mommy; what’s wrong with that man?”). I HAD to scratch, and the result was little blood stains on my socks, sheets, and shirts (hydrogen peroxide gets rid of them nicely, thank God). CeraVe, Triamcinoline; I even tried coal tar; nothing helped. Then I remembered that the maker of Dupixent has a tag line in their commercials; ‘if you need help paying for your medication…’ My dermatologist filled out all the paperwork for me, and a few months later I started getting free shipments (and a Sharps container!). It took a while, but I eventually got 100% clear; I can’t explain the wave of relief I felt. After about a year I took a break but the dermatitis came back, and I went right back to the two week schedule. The program is called “My Dupixent” and I urge anyone suffering from this nasty affliction to apply.
Peggy
My husband must have been one of the first to be given Dupixent for eczema when nothing else he was prescribed worked. When his eyesight began to fail, the dermatologist assured him it couldn’t be the drug. He even spoke to the manufacturer who said they had no reports of eye problems. He saw several eye specialists and eventually was referred to a highly thought-of retina specialist. That doc studied his medications and decided the cause of his eye problems had to be Dupixent and took him off of it. Many months and several extremely expensive eye treatments have followed and must be continued for at least 2 years. It doesn’t amaze us that the Dupixent commercials now mention possible eye problems! True, the drug removed 90& of the eczema but it clearly wasn’t worth it.
Janice
I have eczema, and I find relief with a non-pharmaceutical called Thyme Out. The only thing I dislike is that it comes in plastic and it is so hard to get the labels off the bottle to recycle it. I prefer reducing to recycling. But this helps so much. Also, after I spray on the ThymeOut, I use body lotion on my entire body. It might be the body lotion that does the work though.
Simcha
Why would you use an expensive injection when there are affordable creams? I use the Gold Bond eczema cream and it solves the problem. 3 times a day over both hands.
Becky
I’ve only had eczema for about a year, but the itching has been torture. The steroid cream my doctor prescribed helps a little. I’ve started rubbing the areas with apple cider vinegar twice a day, then following up with organic castor oil to moisten the skin. After about two weeks, I no longer needed the steroid cream at all. The vinegar has been amazingly helpful.
Kate
Kingston
Eczema is a cruel condition. What is even more cruel is the ludicrous and unaffordable price for Dupixent. What is the point in marketing it when it appears that only RICH people can afford it or people with premium health insurance. It’s useless and inhumane.
George
charlottesville, va
I just started this drug yesterday, but for my severe asthma.
Christine A
FL
Dupixent is a miracle drug. My dermatologist tried many remedies before prescribing this as a last resort; I tried many homeopathic remedies without relief, and thought I was going to lose my mind. The itching was making me irritable, sleepless and depressed…..I don’t know what I would do without it now. I have had no side effects that I can tell….I was afraid to give myself injections at first, but now it’s a piece of cake….the relief is incredible….
Susan
Northwest
I find this advice frustrating. My husband has eczema and has not found anything to help. We do not have good insurance. $3,000 per month is out of the question. This leads me to our forever debate about medical care in the US. It is unaffordable and our insurance companies should not even be paying $3,000 per month for two injections. This is absurdly unaffordable.
Carol
Plano, Tx
When I was 19 I developed horrible eczema on my fingers. I used many expensive treatments recommended by doctors. It would improve, but always came back. After about 3 yrs of this, a woman told me she had the same problem until a pharmacist told her to use Geritol. This was before mega vitamins. It contained iron, B vitamins, C and E. I took 1 pill that afternoon, and the next morning my fingers, that had been raw and bleeding the day before, were healed so much that it seemed a miracle. Within days my fingers were completely healed. If I stopped taking these vitamins for a few days, the eczema started coming back. I continue to take these and other vitamins and 50 plus years later have never had eczema again.
JB
NC
There was a study of farm cows in New Zealand and the consistency of zinc levels in their farm feed, because it was being used to control facial eczema on the cows. I found it in Pubmed. I wonder if zinc deficiency is a biomarker for human eczema and whether doctors ever monitor it in dermatology practices, or would a person have to go to a clinical nutritionist to get tested for something like that? So much medical information has historically come from agriculture scientists that it may be an important clue. I suppose one could check food nutrition data lists to see if there are some foods higher in zinc than others, if zinc helps humans cope with eczema.
Laurrie
Southwest
They can keep it!
$3,000 and Side Effects a person can do without.
I read your article looking for help for a friend.