Faculty: Matthew Zirwas, MD
For the afternoon product theater, Dr. Matthew Zirwas explored Dupixent for the treatment of atopic dermatitis (AD). He began his presentation with the statement “what you think of atopic dermatitis is wrong”. Dr. Zirwas reports childhood onset is not a defining criterion for the diagnosis of atopic dermatitis. He relayed the vast majority of patients he sees have adult onset. Dr. Zirwas stated atopic dermatitis is best defined as pruritic and chronic, in a patient with a family history of atopy and with presentation sparing the groin. Atopic dermatitis is a chronic, systemic immune mediated disease characterized by cycles of disease exacerbations that may be difficult to manage. Dr. Zirwas explained barrier dysfunction and increasing immunologic dysfunction with age illuminates why there is adult onset of AD.
Dupixent is an interleukin-4 (IL4) receptor alpha antagonist indicated for the treatment of patients aged 12 years and older with moderate to severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies. There are no contraindications for treatment with Dupixent. Dr. Zirwas stressed Dupixent is NOT an immunosuppressant or steroid treatment. Some patients have dramatic relief of their itch within two weeks of initiating treatment with Dupixent. Dr. Zirwas explains “itch neurons specifically have IL4 receptor on them, therefore, there is a direct neurologic effect of Dupixent on itch”.
Dupixent is delivered through subcutaneous injection. Patients who present with pediatric onset of AD tend to have worse disease which is more difficult to treat, therefore adolescents tend to have a lower clearance rate with the treatment of Dupixent. The most common adverse events for patients who use Dupixent are injection site reaction, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritis, other herpes simplex virus infection and dry eye. Despite the number of ocular side effects, there is no evidence Dupixent causes long term ocular damage. Lastly, laboratory monitoring is not indicated for treatment with Dupixent.