Peers share their insights on moderate-to-severe AD and treatment with DUPIXENT

JEAN: And she goes, “I feel like a million ants are crawling all over me, and I can’t get them off.”

DR GOLANT: When you take somebody that’s lived with some level of daily chronic itch or rash, the idea that there is a version of your life without that is unbelievable to that person, right? It’s interesting even to have that conversation because it’s almost like on some level they don’t quite believe it because they haven’t experienced it. I have a big conversation about what it means to have atopic dermatitis, the fact that this likely will not just solve itself at some point in time.

DR CHOVATIYA: It’s important to think about unpredictability as really one of the key hallmarks of the disease. For some people it might be episodic, some people may outgrow their disease, some may not.

DR SIEGFIRED: That unpredictability has such a big impact on people’s lives. I call it the roller coaster. It’s just because some people have a roller coaster like this, and some people have a roller coaster like this, and when they get here they think, oh, it’s all going to go away. But then they get the next, you know.

JEAN: Well and I think that is Evyn’s case for sure. I feel like our roller coaster was when we were down it was like, oh yay, we’re just moderate. And then I felt like a failure, I’m not doing enough.

DR SIEGFIRED: If they’re doing topical treatment and they’re not getting the response they want, then you say, if you keep doing what you’re doing, you’ll keep getting what you’re getting.

DR CHOVATIYA: When your immune system is overactive or it’s driving inflammation in your skin, you’re hanging out here, the goal is to get you back to here. Historically we’ve always had a challenge with chronic diseases like atopic dermatitis, but with treatments like DUPIXENT, we can really sort of go after it that way.

DR GOLANT: When you are introducing a treatment like DUPIXENT, you’re talking about that selectivity, which is a nice tie-in to talking about the safety profile, and I think aids that conversation sometimes as well.

DR. SIEGFRIED: I like to tell my patients that it has a demonstrated safety profile all the way down to six months of age.

JEAN: We were hesitant of course, because we had questions because of our past experience with all the other things that we tried, but we were ready for something to change.

DR CHOVATIYA: There’s a couple of points that everybody is so used to thinking about with therapy because it’s just the way we always did it. Is this a steroid? Do I have to do some special tests to be on this therapy? So I think balancing each one of those aspects when you’re talking about a treatment like DUPIXENT really helps to spell out the story of, you know, we can check all these boxes of things that are different than what you were doing to really try to go after itch and skin lesions.

DR CHOVATIYA: I feel like the best part of my job is hearing the stories behind everything that we get to do.

JEAN: My daughter Evyn was diagnosed with severe atopic dermatitis, and we were fortunate to find Dr Siegfried. We were lucky to have her help us through her journey with atopic dermatitis. We went from trying everything…the prescription topical therapies, to controlling every part of her environment. The more she scratched, the more inflamed her skin would become. And so she was caught in this vicious cycle that she couldn’t break.

DR SIEGFRIED: Yes, we call that the itch scratch cycle and it is difficult, and that’s one of the ways that it becomes clear that you’re beyond topical therapy.

JEAN: Dr Siegfried, when you explained that DUPIXENT had been studied…it has been studied across adults, children, and now infants…It was the right time for us to try that drug.

DR SIGEFRIED: I think it’s much easier to help make shared decisions with people who have a lot of questions as opposed to making the decision for them. Then you explain the data that we have.

JEAN: Since Evyn has been on DUPIXENT, her itch has almost gone away. Her skin is not as broken out as it used to be and so she just is able to focus on other things rather than the itch and the rash associated with atopic dermatitis. That’s what DUPIXENT gave us… Her skin shows all the time and she doesn’t have to worry about it like she used to.

DR SIEGFIRED: Her skin is clear. To almost clear.

DR GOLANT: Being able to see the progression of these adolescents as they approach more adulthood has been really, really special.

DR CHOVATIYA: In dermatology, we’re oftentimes saying, ok we really want to be able to label something, identify it, treat it, and move on, and atopic dermatitis is very different than some of the other things that we see in dermatology.

DR SIEGFRIED: For the two of you, when you see a patient who comes into your office the first time with moderate-to-severe atopic dermatitis, how do you approach that?

DR CHOVATIYA: The first thing I want to do is I want to talk to my patient and get to know them and say, “How long has this been going on? What is your life like with the signs and symptoms of your disease?”

DR SIEGFRIED: Yeah, what’s the biggest impact? Do you ask your patients, what do you expect? What do you want?

DR GOLANT: For many patients, for example, it’s the itch. It’s the itch burden. I always like to remind myself I’m seeing the patient one, sometimes let’s say 4 days, out of the year. Am I seeing you on a good day or a bad day? Describe the frequency of your flares. Describe your feelings about your level of disease control. And I think when you take that bird’s eye view and you can zoom out and put yourself in the patient’s shoes a little bit.

DR SIEGFRIED: I mean, one of the great things, and also the problems with being a dermatologist is that we are clinicians. We don’t need a lot of labs, but we also don’t have a lot of labs. So we have to depend on our clinical skills to put all those clues together.

DR GOLANT: Sometimes they’re the patients that come to you, you inherit from somebody else, or they just happen to see you for a topical refill, for example, and they’re like, “Yeah, I’m getting by.”

DR CHOVATIYA: There’s the people that are stuck in a cycle of topical prescription therapy use. There’s others who haven’t really had a fair shake of any type of prescription therapy options to begin with.

DR GOLANT: I think supporting my own patients’ journeys through atopic dermatitis has been influenced by my husband’s journey with atopic dermatitis. My husband, when I met him and even today, was very firmly a moderate patient with atopic dermatitis, and watching his journey has changed the way I have the conversation with patients, particularly the moderate patients. It was a big wake-up call, that if I missed the entirety of the burden of disease for him, for this person who I knew very, very well, perhaps I’m also missing the mark when I’m seeing patients in the office. So especially for that moderate patient that comes in my exam room, I really try to take the time to ask about itch.

DR CHOVATIYA: I think that it really always changes all of our perspectives when somebody that’s close to us struggles with a condition that perhaps we have a different insight on. One of my friends struggled with atopic dermatitis for many, many years. This was somebody who was always talking about his extraordinarily scaly, dry, almost reptilian or fish-like skin that he had on his hands and his arms.

DR SIEGFRIED: I fortunately don’t have a lot of atopy in my family, but watching my loved ones scratch…It’s painful. For your patients who have moderate-to-severe atopic dermatitis that you think are good candidates for systemic treatment, how do you explain that to them?

DR GOLANT: Sometimes I’ll share with the patient, “My goal for you is to get you to clear or almost clear, either with appropriate topical prescription treatments, using them the right way or when those are not meeting the mark, that we’re going to have a conversation about our systemic therapy options like DUPIXENT.”

DR CHOVATIYA: And we know that when it comes to this disease state, there’s a few key drivers that we think about that are oftentimes little signals floating around in the immune system. Two of these signals are part of an overarching program of type two inflammation, IL-4 and 13.

While they’re not necessarily the only signals in the immune system we think about, they’re important because they have roles both centrally and peripherally in the body for making more of these immune cells that are overactive, as well as also making the barrier further disrupted, making the immune system further dysregulated, and really amplifying up the itch that you see.

DR GOLANT: When you actually get into the nitty-gritty of that DUPIXENT conversation, it is the demonstrated safety profile that we know.

DR CHOVATIYA: With something like DUPIXENT that showed improvement not only in the signs of disease but symptoms, I feel like now we actually double and triple down on the fact that you have to talk to your patients, particularly about symptoms like itch, because that is an important dimension and part of the disease, and the only way we really learned all about that is because we were able to study those kinds of outcomes with a medication like DUPIXENT.

DR GOLANT: My husband, when considering treatments for him, wasn’t the patient that I automatically thought of treating with a systemic therapeutic. And I think when we got to that point, when my husband made the decision to start a systemic, he ended up starting DUPIXENT. That was his journey and he’s still on it, doing well.

DR CHOVATIYA: It’s been so wonderful spending time together and really diving deep into not only atopic dermatitis as a disease itself, but what DUPIXENT has done for a lot of our patients and really thinking about how you guys approach practice in the real world.

DR SIEGFRIED: It’s been such a pleasure and so much fun to get together with you guys and talk dermatitis, what we live and breathe.

[Soft music playing]

DR SEROTA: This is really what I love talking about, is inflammatory skin diseases and the different treatments.

DR GUPTA: We are getting consults in all different ways, but we are seeing more of that moderate-to severe patient, for the most part. So for all of you guys, when do you classify somebody as moderate, not severe?

DR CLORE: Moderate eczema has many different subtypes, too. So, you might have a young man who’s a musician who just has hands and wrists. Or you have someone who works in television and they’ve got it all over their face and neck, but yet the rest of their body is clear. That will be moderate because it’s impacting them, so you have to factor all those things in.

DR SEROTA: Eczema is the itch that rashes. It could be anywhere on the body. It’s easy when it’s the folds of the elbows, the folds of the knees, the cheeks of the child. I think one other point is how much it affects the whole family. It’s the whole household that really gets impacted by this kind of a disease.

DR GUPTA: So what can we use for this patient that makes sense for their lifestyle? Because a lot of times these patients are walking away with like 20 different things that they need to do throughout the day, and it doesn’t make sense, especially for atopic dermatitis, right, we’re wanting them to moisturize their skin like 20 times a day.

DR SEROTA: What I don’t think we’re doing as great a job yet is measuring how well their eczema is doing by how much topical steroid they’re using. We should probably be asking “How often are you needing your topical steroid?”

DR GUPTA: Especially nowadays, we get people, they’ve been stuck in that cycle of just using the topical therapies, stronger topical therapies...

DR CLORE: We want to make it better for a period of time to where we’re not complaining about itch. Then, we sit down and have a shared decision discussion and see how we do for a period of time.

But they come in, they’re trying to slather a steroid topical therapy on 80% of the surface area twice a day...

DR GUPTA: ... that’s the great thing about dupilumab. We’ve been using this for so long.

DR CLORE: How much does it impact your decision-making that a medicine like dupilumab...It’s not an immunosuppressive.

Absolutely and it’s one of the things that I discuss with patients when I’m talking about DUPIXENT as a potential therapy.

We’re targeting very specific areas of the immune system that needs to be targeted in order to cut down on the inflammation.

DR CLORE: I just think the demonstrated safety profile of dupilumab makes you much more comfortable having that discussion at that first visit.

The most common adverse reactions with an incidence of greater than or equal to 1% are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

DR SEROTA: I think DUPIXENT has shifted the way in which we treat the disease.

And some patients might be ready for that, some patients might want to do more research themselves first, but the point is, they should know that these treatments exist.

DR CLORE: We all have great patient stories to talk about with dupilumab, but I think one of the ones that stands out for me is a 16-year-old young lady.

She said, “Look, Doc, the reason I’m here is these lesions are on my face and my hands, and I just got elected to the prom court. Everybody’s looking at my lesions on my face and my hands. Can you do something about that?

Because dupilumab was on the market, we had an early discussion about systemic therapy. She had already tried numerous topical prescription therapies, so she was having a lot of itching and a lot of scratching.

And we saw her back the week before the prom, and her itch had improved dramatically. She had no itch at all through the evening and was much more comfortable with the way she appeared. And so she was really excited.

She comes in the office, and she just jumps up and hugs me. Being a hero every once in a while feels good.

DR SEROTA: There’s not too many chances in medicine where your patients give you a hug at the end of the day.

So you got to take those wins where you get them.

DR GUPTA: Thank you both so much for being here today and allowing this discussion to take place about dupilumab.

Hearing patient stories and the way that different doctors approach the medication is so helpful.

TRACEE BLACKBURN: Patients always ask, “Why dermatology?” And, “Why did you choose it?” And I say, “Dermatology chose me.”

INDICATION

DUPIXENT is indicated for the treatment of adult and pediatric patients aged 6 months and older with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. DUPIXENT can be used with or without topical corticosteroids.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATION

DUPIXENT is contraindicated in patients with known hypersensitivity to dupilumab or any of its excipients.

LEIGH ANN PANSCH: You know, one of the things that really has been profoundly impactful to me is my own experience with my three daughters who all have had atopic dermatitis.

LAVINIA DRAMBAREAN: Atopic dermatitis has been something that one of my children has dealt with. I’m also a mom of three. I have two boys and our little girl at the end, but it’s my middle son who has been most impacted by atopic dermatitis. He has had situations where it’s been moderate, but then he’s had those severe flares.

TRACEE BLACKBURN: I have a personal story as well. So my bonus son, when I met my husband, he had a six-year-old. And I would see him itching and scratching and it’s like a never-ending cycle.

LAVINIA DRAMBAREAN: We were in this constant battle of flares, treating the flare, then he would do fine for a little while. And then we just found ourselves back in this cycle.

LEIGH ANN PANSCH: I think the impact not just on controlling disease for that child, but the trickle effect of how it affects the other family members is absolutely profound.

LAVINIA DRAMBAREAN: I do know that it can be really cumbersome, some of the things that we ask our patients to do and the things to apply. And I do prescribe topical prescription regimens at that first visit. I always like to say, “Hey, I want you to come back and let me know if things are not working, and whatever that might mean for you, I want you to let me know.”

LEIGH ANN PANSCH: I’m curious, as providers with as much experience as you have, how do you get to those questions that really tell you that a patient needs more than just topical prescription therapies?

TRACEE BLACKBURN: I ask them what their daily routine is, and I also ask them, “Are there any times when you are clear?” So “moderate-to-severe” to me is not just about what I see, but also what they’re experiencing.

LAVINIA DRAMBAREAN: I think the question of “Is your skin ever clear?” is such an important one because it really does identify any gaps in therapy. They’re not aware that there’s a systemic option available.

TRACEE BLACKBURN: I always try to bring in that conversation within the first or second visit just so they have that option in the future.

LEIGH ANN PANSCH: I like to think of it as an open conversation with some dialogue about options.

LAVINIA DRAMBAREAN: I’ll say, “Think about your atopic dermatitis as this leaky pipe and you’ve got all this inflammation that is just cascading out, like this water that’s just loose.” And they seem to understand really like, “Okay, I get it. This is overactive.”

TRACEE BLACKBURN: So when I have the patient that is in the office and they’re ready, I introduce them to DUPIXENT. And then the first thing they’re like, “Is that gonna..is that a steroid?” And I was like, “Nope, it’s not a steroid.”

LAVINIA DRAMBAREAN: I think it gives me a unique perspective when I’m counseling patients on starting therapy because on top of saying, “it’s not an immunosuppressant, it’s not a steroid, it doesn’t require lab work,” I can say, “And you know what? This is something that has affected my life and that of my child, and I want you to know that I know where you are and I can meet you where you are.”

LEIGH ANN PANSCH: I find patients really willing to accept. And so it’s a great opportunity I think just to remind them about the safety profile of DUPIXENT. The most common adverse reactions with an incidence of greater than or equal to 1% are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

LAVINIA DRAMBAREAN: I tell my patients when they ask about what can DUPIXENT do for them, I’ll tell them, “I feel like my goal is to help you get to your goal, which for me is always clear skin and as clear as we can get, but also helping with that burden of itch.” I have a patient that comes to mind. He was seven years old, and he had already suffered with atopic dermatitis most of his life. This poor kiddo just hardly had a spot on his body that was clear. And once we were able to start him on DUPIXENT, he started to have more clear skin. And for me, as his dermatology provider, gave me that satisfaction of like, okay, I feel like I’ve been able to make some impact, and not really due to me, but due to DUPIXENT.

TRACEE BLACKBURN: Absolutely, I think that after this conversation, I walk away knowing that there are providers out there that care just as much as I do for the patients that we treat.

LAVINIA DRAMBAREAN: I agree. Thank you so much.

LEIGH ANN PANSCH: I’ve really enjoyed being able to talk with you, but most importantly, so excited to talk about a therapy called DUPIXENT that has changed the treatment landscape for so many of our patients with moderate-to-severe atopic dermatitis.

TRACEE BLACKBURN: Absolutely.

LEIGH ANN PANSCH: I have a partner who says it best and he says, “Dermatology is an art,” and specifically medical derm is what drives me.

INDICATION

DUPIXENT is indicated for the treatment of adult and pediatric patients aged 6 months and older with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. DUPIXENT can be used with or without topical corticosteroids.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATION

DUPIXENT is contraindicated in patients with known hypersensitivity to dupilumab or any of its excipients.

TRACEE BLACKBURN: I always like to say, “Bring in your products, take pictures. I want to see the whole countertop and I want to hear your skin story.”

LAVINIA DRAMBAREAN: Really getting a great history of what you’ve tried and failed, and sometimes they don’t know what they’ve tried and failed.

LEIGH ANN PANSCH: When a pediatric patient comes in with their moderate-to-severe atopic dermatitis. One of my favorite questions is, “Okay, Mom, Dad, how many times in a week on average does your child need this therapy?” And, “What is your moisturizer? What is your emollient?” And a lot of times, they’ll give me an answer and then I say, “Okay, how many times in a week on average are you using this therapy?” I think these are the types of questions that my medical assistant knows to put in quotes, “Mom states, Dad states, caregiver states...”

TRACEE BLACKBURN: When you realize that you’re going through a whole hour of putting the ointments and the lotions on, then this is when the conversation is like, “I can do this all day on your skin, but what’s actually going on? And what’s underneath your skin?”

LAVINIA DRAMBAREAN: Having these conversations with parents and caregivers about, “Okay, we’ve failed our topical prescription regimens, now we need to talk about systemic therapy.”

LAVINIA DRAMBAREAN: I think, once DUPIXENT came out not only did it change the landscape of therapy for our patients, we now had this tool that really ended up becoming something that we championed for our patients. When you talk to a patient and you’re like, “Okay, it’s not an immunosuppressant, it’s not a steroid. You don’t need blood work.” And then same thing, that light-bulb moment goes off and they’re like, “Oh, okay.”

TRACEE BLACKBURN: So I tell my patients that I literally think in cartoons, so I call it the “itch posse” that’s underneath the skin, and all of a sudden you’re scratching and itching. I said, “What DUPIXENT does is it goes in and it’s like, we have to work it from the inside out.”

LAVINIA DRAMBAREAN: This medicine works from the inside out. And also it has a demonstrated safety profile for patients as young as six months old. The most common adverse reactions with an incidence of greater than or equal to 1% are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

LAVINIA DRAMBAREAN: Sometimes it’s us as the providers wanting more for the patient. They don’t know that there’s an option that’s available.

TRACEE BLACKBURN: Absolutely. It brings me to a three-year-old that I saw in the office. And the concern was, yes, the patient had atopic dermatitis. And so we had a couple of follow-ups, but they weren’t improving. And Mom said, “You know what, I am doing everything I can. We’re using this cream and we’re doing this and these topical prescription therapies and it seems like when I stop, it just comes right back.” And I said, “Well, I think we need to talk about another option because if we don’t control her atopic dermatitis, you’re going to continue with this cycle.” I said, “Have you heard of DUPIXENT?” And she’s like, “I heard of it, but I just don’t know anything about it.” And I’m like, “Well, let’s have a seat and let’s talk about it.” So at the follow-up visit, she says, “I think I’m ready. I really need to get this under control.” And so I said, “Well, I think it’s time for us to make that change.” And I just saw her after, and she’s doing well and controlled.

LEIGH ANN PANSCH: I really want to just thank you both for this incredible opportunity to talk about DUPIXENT that has changed the treatment landscape for so many of our patients with moderate-to-severe atopic dermatitis.

TRACEE BLACKBURN: Absolutely.

LAVINIA DRAMBAREAN: It really has.

[ADAM FRIEDMAN, MD]

There’s the two gallon, uh, Ziploc^® bag of all the rolled up topicals, and the answer is usually, “None of these worked.” …Well, what do they mean by that?... “Well, it got better, but then it came right back, and it got better, and it came back, and I’ve given up.”

[SANDRI JOHNSON, NP]

The things that are tried, whether it’s the pediatrician or primary care provider, of course there’s algorithms that are followed...and you have to be really prepared to make jumps into more appropriate therapies.

[LISA SWANSON, MD]

In a visit, no matter what condition I’m treating, I try to do 2 main things. The first, educate the patients. And then number 2, provide hope.

[Narrator VO of on-screen INDICATION and IMPORTANT SAFETY INFORMATION; no captioning necessary]

INDICATION

DUPIXENT is indicated for the treatment of adult and pediatric patients aged 6 months and older with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. DUPIXENT can be used with or without topical corticosteroids.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATION: DUPIXENT is contraindicated in patients with known hypersensitivity to dupilumab or any of its excipients.

[LISA SWANSON, MD]

One of my biggest pet peeves in dermatology is the minimization of eczema…because even if I meet a child at two, they’re suffering and struggling at that moment in time. And I’m not going to wait for them to just outgrow it.

[LAUREN MILLER, PA]

The signs and symptoms that I typically see for uncontrolled moderate-to-severe atopic dermatitis are erythema and scale. You may see some of that lichenification, um, in certain areas. You may see some excoriations.

[OMAR NOOR, MD]

So, when you have a patient with a darker skin type…we recognize that the clinical appearance of their skin can sometimes differ from a lighter skin type. And that violaceous color of the erythema can sometimes be lost in a darker skin type.

[ADAM FRIEDMAN, MD]

With AD, itch is number one for me. That is always the first question I ask…the itch that feels so great to scratch that that patient is so embarrassed that they feel the need to scratch.

[PRIYA BANSAL, MD]

I think the bottom line really is is that you’re getting an inflammatory process in the skin, and unfortunately, that inflammatory process is leading people to itch.

[LISA SWANSON, MD]

Their barrier’s impaired. And then why do we use the medications that we use? We’re trying to target that inflammatory process.

[SANDRI JOHNSON, MD] We will always need a moisturizer that helps us with that barrier dysfunction, but we need to treat that overreactive immune system.

[ADAM FRIEDMAN, MD]

We’ve learned quite a lot, and these include signals such as interleukin 4, interleukin 13…and then designing an approach that interferes with that inappropriate signaling of that pathway that we know and love so well, atopic dermatitis, well that makes sense.

[OMAR NOOR, MD] He had already tried and failed medium- to high-potency topical corticosteroids, as well as topical calcineurin inhibitors. And he recognized, at least at that point, that those medications were not working well enough for him.

[LISA SWANSON, MD]

And previous providers...they treated him appropriately up to a point. I’m so glad that eventually the new pediatrician they saw said, “Clearly, these strategies are not enough…We need to get dermatology involved.”

[OMAR NOOR, MD]

It’s really that communication, appreciating why DUPIXENT was a good treatment option for him, allowed him to feel comfortable in me, to trust me, to then start treating him. You know, it’s a whole process...and we really got there.

So tell me who you are.

EMAAN: My name’s Emaan. I’m a nurse in Chicago. Being, like, a full-time patient with Dr. Bansal is just kind of like full-circle moment, how like me and her know how to communicate now about like healthcare and how we feel about it.

DR. BANSAL: I’m Dr. Priya Bansal and I have known Emaan for years and years. I am an allergist/immunologist.

So what is it about this field that you love?

DR. BANSAL: Allergy/immunology is extremely fascinating. How do our bodies affect us in different ways? That’s what allergy/immunology does, tie together all of those different puzzle pieces and put it together for the patient.

DR. BANSAL: When I first saw Emaan come in and you see this little kid, and, kind of looking away, just, kind of doing this, itching, different spots. She’s not comfortable, the skin is flared, she’s trying to cover up those areas, cause she doesn’t want people to look at it, right? And moderate-to-severe atopic derm, you do, you do suffer, especially if it’s like over here or even on your hands, and face is also very traumatizing, because it’s so visible, right?

EMAAN: I almost felt a little bit more hopeless. I’d been to like, three dermatology office, I was at another, like, clinic before that. I was sick of it at that point.

DR. BANSAL: What’s the point?

EMAAN: What’s the point? Like, I had to wear long sleeves, I had to do this, I had to do that.

DR. BANSAL: I think the hard part for me, there were huge gaps where I didn’t see her because I could tell she was so frustrated, and she was so over it, especially, I would say the late teen years.

EMAAN: It felt like I had no more options because I had tried everything under the sun. Like, all it was doing was putting a band-aid on my problem.

DR. BANSAL: When it first came out, I remember thinking to myself, I was so excited, like I was counting the days ‘til it came out. Because I knew that I had in my head this list of patients.

EMAAN: And you were like gonna have this new thing that came out, it’s called DUPIXENT, and she’s explaining everything to me, and I said, that’s cool. No.

DR. BANSAL: But no (laughs).

EMAAN: That’s not happening, I will not be doing that. I created that normal for me where I was like, this is how it’s gonna go, and I’m not gonna try something else. And then I became a nurse.

DR. BANSAL: (laughs)

EMAAN: And I was like, hmm. What is different about this drug? And I didn’t want it to be an immunosuppressant, I was a little nervous about that.

DR. BANSAL: I mean, that was the biggest thing. Yeah.

EMAAN: It was a biologic.

DR. BANSAL: Those are the two things that patients need to understand. Because you hear the word ‘biologic’ and there’s so many different biologics on the market. DUPIXENT specifically works on type 2 inflammation by blocking the receptor. DUPIXENT is the only dual inhibitor of IL-4 and IL-13 signaling. I think what makes DUPIXENT really unique is its safety profile. The most common adverse reactions, with an incidence of greater than or equal to 1 percent, are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

For me, the beauty with DUPIXENT is, is that it’s not an immunosuppressant. DUPIXENT has no known drug-to-drug interactions and is not metabolized through the liver or excreted through the kidneys. There is no initial lab testing or ongoing monitoring required, according to the Prescribing Information.

EMAAN: I just remember I, coming back in her office, and I’m like, Dr. Bansal, you won’t believe it. I didn’t have the intense itching. It was very different from when, that first month I came in, to like, that 16-week mark, around there, when I came back in.

DR. BANSAL: I think that was the biggest thing, coming in, like today, like, that’s why I’m getting all choked up.

EMAAN: It’s just, it’s been a process, for twenty years, like, of just this, and like, feeling like, no hope.

DR. BANSAL: We had seen the studies, and I had seen the papers, and seen, um, pictures of what could happen with the skin. I mean, look at her (laughs). You know, like the analogy I give a lot of the patients is, you know, I don’t want you to be the passenger seat, right, of your health. Like, I want you to be in the driver’s seat. I mean, that would be my message to anybody who was looking into doing DUPIXENT, right?

EMAAN: I really was skeptical, but now, kind of being in my journey in DUPIXENT, I do wish that I did take it sooner, you know, however long ago that was, and not waited. And I wish I’d kind of gotten my driver’s seat, like you like to say, and kind of just took control from there.

And why don’t we just go ahead and get your introduction.

Swanson: I’m Lisa Swanson. I’m a dermatologist and pediatric dermatologist in Boise, Idaho. Dermatology is awesome. I grew up with a dad who was a urologist and he would tell me, “Lisa, there are two kinds of doctors.” “Urologists and those who wish they were urologists.” And I would say, “Dad, I don’t think that’s the case.” And now I know for sure that’s not the case—it’s dermatologists and those who wish they were a dermatologist.

Rachel: My name's Rachel, and I am born and raised in Idaho, and I have three boys, and today we’re focusing on my son Bear, who’s the youngest of the three.

Rachel Voiceover: It started with just patches in the beginning and then over time, it progressively got worse, and so we started asking his pediatrician questions, and we tried all these different tests and diet changes and all these different things.

It started with just patches in the beginning and then over time, it progressively got worse, and so we started asking his pediatrician questions, and we tried all these different tests and diet changes and all these different things.

He would get the sores that would break open and get infected and we’d have to go into like an urgent care, they would say, “Oh, it’s probably eczema that he’ll just grow out of.” And they would just provide a topical treatment, some type of prescription.

I finally reached out to a pediatric nurse that said right away, “You should go see this dermatologist.” And we thought, “Wow, I’ve never even considered a dermatologist.”

At my first visit with Bear, he was covered in eczema, no doubt about it, severe. And his BSA, body surface area affected, was basically 90%. He was six years old the first time I met him. Uh, and darn cute.

You could just tell he was horribly uncomfortable because of the itching. He was pacing the room, scratching, couldn’t get comfortable. One of my biggest pet peeves in dermatology is the minimization of eczema. I’m not going to wait for them to just outgrow it. And the cool thing about my job is that I can confidently say that we can help.

All the topical creams and different treatments that we tried, it was all like small Band-Aids that just weren’t cutting it.

I remember she was looking directly at Bear and she said, “There is something that can help you. Your skin won’t always look like this.”

She was like a ray of light, and it was very hopeful. And we just had never had that.

I was thinking I’m definitely going to start Bear on DUPIXENT today. And then I had to segue that to a conversation with his parents and with Bear himself, to make sure that was cool with them.

And so, I talked first with Bear’s parents and I explained that DUPIXENT works on the inside to treat the eczema on the outside. How it works is that this inflammatory process is turned up in atopic dermatitis.

I explain that it has a generally consistent safety profile that’s been established in patients as young as six months old. The most common adverse reactions (incidence ≥1%) are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

I also make sure to mention that it is not an immunosuppressant, it is not a steroid. There’s no requirement for any blood or lab monitoring, and I think it would be the right choice for Bear.

All those sort of medical points that she made were very reassuring.

And then I turned my attention to Bear. And I’m like, “What if I told you that there was a medicine that could make your skin look better and could make your itch get better. Does that sound like a good thing?” And he said, “Yeah. I would definitely do something like that.” So, we made the decision together to start him on DUPIXENT.

After being on the medicine for 16 weeks, Bear was doing amazing. The itch was minimal.

Which was really meaningful to him, because it really bothered him. And so, to notice that had gotten better was a big deal to him.

When I was talking with Bear and his parents about treatment options and potentially going on DUPIXENT, I discussed all the various options that were available, but in my heart, in my brain, I knew that I wanted Bear to be on DUPIXENT.

It was so reassuring and so comforting to know, uh, what DUPIXENT was and what it wasn’t. That just immediately made us feel comfortable.

I’m just so grateful that we met you and just willing to get on Bear’s level, and see the child that he could be. The child that he was meant to be, living without the constant itch.

If you could just introduce yourself to me however you like.

I’m Dr Adam Friedman. I am Chair as well as Resident Program Director at GW School of Medicine and Health Sciences. My investment in dermatology has only grown, and every day I learn something new. Every day is different, and I honestly cannot see myself doing anything else.

This patient could be so many, especially when it comes to atopic dermatitis, a condition that affects millions upon millions of individuals just in the United States alone, but in this particular case, what really stood out to me was this immediate sense of, “Please help me, I need to get better.” So, this was a 16-year-old male who had light skin. He had a pretty extensive disease, signs of chronicity that he had been scratching, and so even right then and there, I saw him rubbing his arm—it’s almost impossible for these patients not to—and it opens the door to ask questions about itch. How frequent it is, how long it lasts, does anything help? Does anything make it worse?

So, for him in particular: young guy, loves sports, plays basketball, relayed to me he couldn’t play basketball because of how sweating affected what I was seeing on his skin. Those to me all are very good metrics of severity. And so putting that all together in the clinical picture, you know, you can really get to the root of the diagnosis.

So, I really just jumped into—and we all have them—my kind of script to explain what this condition is, and why it is happening. There’s a problem with the armor that allows water to get out, and things that shouldn’t be getting in, to get in, that also can fuel that immune fire. He’s been on multiple prescription topical therapies. They’ve done maybe their part, but not enough.

He was DUPIXENT ready, which is why I took the time to explain all these things. You also have to convince Mom or the parent in the room when you’re dealing with a minor. But, going through this course and walking them through, taking the time, allowed me to be able to prescribe the medication that I knew was right for the patient.

We’ve learned quite a lot, and these include signals such as interleukin-4, interleukin-13. And then designing an approach that interferes with that inappropriate signaling of that pathway that we know and love so well, atopic dermatitis, well, that makes sense.

One of the easiest talking points when it comes to talking about DUPIXENT for AD, is the lowest age of approval. Because to be able to say that this medication is approved for six months and up, that usually does it. And so that opens the door. What is the safety profile? The most common adverse reactions with an incidence of greater than or equal to 1% are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

Being able to say that there are no known drug-to-drug interactions is really important. Teenagers, among probably most other people, do not like getting blood tests. Who can blame ’em? Who would? So, one of the really valuable elements in the Important Safety Information is that we do not need to do any prescreening, no labs. So, great. They agreed. We’re gonna do DUPIXENT.

I have all my patients undergo injection training in the office. And I think one of the very useful elements of how the loading dose is structured, which is two shots at the first time, it allows us to show them how to do it. And then we watch them do the second injection.

So, when my teenage patient wrote me at two weeks, there was a little anticipation to see what was he gonna say. And he was ecstatic. You know, he wasn’t perfect, and I didn’t expect him to be, but he was noticing improvement, more so than past experiences. Then he came back with a smile on his face. I look for a change in nonverbal cues, which I also encourage when you see these patients for the first time. Pay attention. Are the lesions cleared? Could be markers for treatment success.

This patient sent me a message about how making the right diagnosis, educating him on the diagnosis, but starting him on specifically DUPIXENT, has changed his whole perception. I would have to say hearing the impact of a therapeutic approach that I initiate for a patient is extraordinarily rewarding. I have to say, and this is important, you don’t want to get caught up in one moment because there’s so much more to do. But it’s okay to appreciate the win.

Marker.

Great.

If you could just introduce yourself to me any way that you want.

My name is Lauren Miller, and I’m a dermatology PA practicing in Oxford, Alabama, which is a rural area about 60 miles east of Birmingham. I’m from the South, and I love asking my patients about their families and what they do for a living, and just really making a connection with them. And so part of that is making that connection so that not only do they feel comfortable with me, but also it helps me to understand better how I can help them. So it then kind of becomes my mission to figure out a way that I can make this patient feel better.

So, I go into the room, and I have this 8-year-old little girl who’s sitting on the bed like this. So, I move over and start talking to the mom, and she tells me that she has been seeing their pediatrician now for several years, and all they’ve been given are topical creams, and that she is desperate for something to make her daughter feel better. She had erythema, which was a little bit difficult to identify because she’s Fitzpatrick 6, she’s very dark, um, and so, the pediatrician had actually misdiagnosed her early on, and really couldn’t tell, um, that she had atopic dermatitis. So, erythema now looks violaceous. You could see the lichenification in certain areas, which told me that she’d probably had this disease for quite some time.

And so, this patient was moderate, I gave her an IGA of 3 on that first visit, but on an NRS scale, she was a 10, which was the worst itch that, um, the patient could imagine. It was affecting her day and night. You can imagine that if a daughter is suffering day and night, then the mother is suffering day and night as well. The daughter had had so many topical prescription therapies that she was over it. She was over having to rub something on the skin.

So, the mom said, “You know, look, there’s days where I can’t get this on. She just won’t let me do it. She won’t sit still long enough to put the therapies on.” As time went on, I was able to kind of build a rapport with her, and I was able to kind of figure out that not only was the itching an issue, but it was the way her skin looked as well. So she didn’t feel comfortable wearing certain types of clothing. She didn’t feel comfortable going to pool parties.

And it broke my heart for her to tell me that she felt that her skin lesions, um, were ugly. Sorry.

Can we just take a breath?

When deciding what therapy I was going to put this patient on, I thought of 2 things. One was her age, and one was safety, and it was indicated for her age group. And I felt that DUPIXENT had a balanced safety and efficacy profile. The most common adverse reactions with an incidence rate greater than or equal to 1% are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

DUPIXENT has no known drug-to-drug interactions and is not metabolized through the liver or excreted through the kidneys. There is no initial lab testing or ongoing monitoring required, according to the prescribing information. DUPIXENT is contraindicated in patients with a known hypersensitivity to dupilumab or any of its excipients.

So the mother was on board 100 percent. She said, “Sign me up.” I wanted her to understand why it was important that she was getting a therapy that was an injection.

I like to explain and did explain to her that the prescription therapies that she had used in the past were things that had been applied to the surface of the skin, um, whereas DUPIXENT was something that was going to work from the inside out to help her skin.

After 16 weeks of being on DUPIXENT, the patient described her skin as not itchy. And this was definitely the point where the little girl that came in that initially was kind of looking down like this and had a, a scowl on her face. I did the exam, and I could definitely tell a huge difference from that very first visit.

And I could see that each visit, that smile on her face got a little bit wider, and a little bit wider. She’s my BFF. She brought her little jelly purse in, and she wanted to show me all the stuff that was in her purse. She was really excited to tell me that she was able to go to a pool party and she told me all about it. And Mom was in the background, you know, just dying, and um, y’all are gonna make me cry again.

The thing I love most about dermatology is the ability to not only make somebody look better on the outside, but make them feel better on the inside. The whole experience really was a highlight, um, because that was probably one of my earlier experiences with using DUPIXENT, in a child.

If you could just introduce yourself any way that you want.

Sure, so uh, my name is Omar Noor, I am a board-certified dermatologist. I have practices in New York and New Jersey.

Tell me what you love about dermatology.

People really see the issues that they have, and it really affects them on a deeper level. So being able to help these patients is really the thing that I love most about what I get to do.

When I first met with the patient, when he came into the office, I had a little bit of background already from the patient’s daughter, um, who is a dermatologist. He was a 62-year-old male, um, with a Fitzpatrick skin type of roughly four to five. With uncontrolled moderate atopic dermatitis, it is chronic over time, but it is not consistent.

He talked about how he had been struggling with atopic dermatitis for at least 10 years. The erythema can differ slightly and be a little bit more violaceous, or more purple, and that violaceous color can sometimes be lost in a darker skin type.

You have to really pay attention to these unique differences in order to diagnose the patient correctly. He had moderate atopic dermatitis, but his most bothersome symptom was itch. He was frustrated with the way that his atopic dermatitis was causing his itch to be unmanageable.

When I sat down, he was there clawing away at his skin. He described it as just fire on his skin. He had already tried and failed medium- to high-potency topical corticosteroids, as well as topical calcineurin inhibitors.

When talking with him around putting him on DUPIXENT, he was a little bit apprehensive around injecting himself. He had about 20% of body surface area covering him… I explained to him that if we biopsied those areas that had no atopic dermatitis and we looked at it under the microscope, we could still see subclinical signs of atopic dermatitis. He was very appreciative in that understanding why he was having these flares—and why it wasn’t his fault.

Once he understood that this was more of a internal problem, that’s how the discussion started about treating this more systemically. The injection is meant to be utilized as a systemic delivery of the medication. His atopic dermatitis would start to improve within the first 4 months.

And being able to explain that, “You may have been on steroids in the past, but this is not a steroid.” There are are no known drug-to-drug interactions for DUPIXENT.

The safety profile was appropriate for this patient. The most common adverse reactions (incidence ≥1%) are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

So we started with his loading dose at, on that day because we didn’t have to check blood work. So once he got to see what it was like to get that injection that he was apprehensive about, he was much more comfortable with doing that injection himself.

After 2 weeks, he had now started to see improvement in itch, as well as improvement in his visual, moderate atopic dermatitis. You know, when I first saw him, he talked about how he felt his skin was disfigured, his skin was stained and that people were judging him by the way that he looked. And to see his excitement: he was there no longer as a patient that didn’t know what was gonna happen next; he was a follow-up patient that was on track.

To be able to see him back at 1 year, he came in excited to come into the office to show he was visibly seeing improvement in those lesions, in what he thought could potentially not get better.

This is what I strive for, with every individual, with every patient that I see. You know, these patients come in and they... They’re at their wit’s end. They’re, they’re uncomfortable, they’re itchy. It affects everyone around them, not only them, and when you can see them get better, they... It’s... It just feels different for me. You know, I get to appreciate their improvement.

Marker.

Tell me who you are.

My name is Sandri Johnson. I am a dermatology nurse practitioner in Rocky Mount, North Carolina.

Tell me what it is you love about dermatology.

I love working with people of all ages and make them feel comfortable. As a nurse practitioner, that’s the way that we are trained, a holistic approach. You are not just treating a body part that has a problem. You are treating a human that has a problem.

In our office, we treat a lot of patients with atopic dermatitis. Some of them are extremely memorable. There’s two persons specifically that just stick to my mind because it is unusual, and is a father-daughter pair. Met the father first because the daughter had not been born and he was in his early 30s when I met him. He had had atopic dermatitis all his life since childhood. And he has been suffering from severe atopic dermatitis for many years. He was very quick to talk about how itchy he was and how desperate that made him feel. He immediately rolled off his sleeves and hiked up his pants and showed me all these lesions and what this itch was doing to his skin. He had dark skin tone, African American. His skin was becoming extremely thickened and actually lost pigment in the front of his shins and his legs.

He was tired of using the topical prescriptions that were messy. His job was an outdoor job where he would sweat a lot and the prescriptions that you put on your skin were just basically running off and uncomfortable.

When he brought his daughter in, he was already extremely scared. She was actively itching in the office. She didn’t stop. Moderate to severe, but more on the severe side. The most emotional part of that visit is when he spoke about how he knew, he knew how she felt. This was so ingrained into his own soul about the feeling of desperation of itching, and this is an infant there. I understand that deeply. I, myself, have atopic dermatitis so I can empathize with that person when they’re coming in and telling me how they’re feeling about, not only the itch, but what they’re having to do for that itch.

They need to know that there’s something out there that can really treat their condition and control that itch. So, we talked about DUPIXENT the day that he came, on the first day.

The biggest reason that we prescribe DUPIXENT is its safety profile. The most common adverse reactions with an incidence of greater than or equal to 1% are injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, and eosinophilia.

We talked about it not being an immunosuppressant. We talked about not having to get laboratory monitoring and we actually started the medication on the first day that he was there.

So when he came back in 2 weeks, yes, he was already experiencing a reduction in the itch. That was very satisfying to him. When he came in for follow-up, after being on DUPIXENT for a few months, he talked about the sense of relief, how much improved he was, not only about itching, but also on how the lesions were looking. When I saw the dad at 16 weeks you could definitely see an improvement in his lesions.

By the time the daughter came in and the father knew already what this journey is like he was hopeful that the same therapy that he was on would be someday available for his daughter. She had lesions on her face, on her thighs, on her belly, in the bends of her elbows, and the neck, you know, babies basically have no neck. So this was really macerated around her neck. At that time DUPIXENT was not approved for her age group.

So he was going online and looking for that approval, see, but he basically knew the day that I knew that DUPIXENT was approved down to the age of 6 months and older. So he was ready to go. She was almost 2 at the time.

For about 4 months, they came monthly to the office and we did the injections there—let us be the bad guy. And by 16 weeks she’s sitting there playing and she was no longer itching in the office, in front of us.

When we saw his daughter, the skin was clearing. It was great. He knew that he was doing for her what he was able to achieve for himself, that control, where the condition is not controlling you, but the other way around, you’re controlling it.

When you’re making these big decisions to take control of your own atopic dermatitis, you need to be applauded and be told that, yes, you are. Somebody’s proud of you, and that’s me.