Local and systemic treatments for AD

Casey Butrus, PharmD: Dr. Cameron, what factors do you consider when deciding to prescribe topical and systemic treatments? mosquito [AD]?

Michael Cameron, MD, FAAD: that’s a great question. Unfortunately, when it comes to treating Alzheimer’s disease, most patients still require topical medications, and most patients do not reach his EASI when considered effective, like Upadacitinib and Rinvok. [Eczema Area and Severity Index] 100. Remember that the EASI 100 is a dichotomous endpoint. Measured at one time point only. If you follow the patient and check the EASI 100 daily, at some point you will get a rash. Most patients will need creams at some point. The question in my eyes is do they need the whole body. That’s the operational question. How do I decide whether to use only topical agents or a combination of topical and systemic agents?

For me, it is caused by the patients and how debilitating they are finding their disease. Suppose there is someone Let’s say they consistently use topical steroids, practice good skin hygiene, and take care of their skin. Fortunately, like dupilumab and Advry, these biologics are very safe. [tralokinumab] and lebrikizumab. I think JAK is also very secure. From my point of view, if these patients are not cured, they should be treated.

Brian Keegan, M.D.: Also important is what the patient says they want and what they actually want. The two of us, and hopefully a lot of people out there, dig into that with the patient. We may go through their charts or discuss the multitude of drugs they have used and find that they have tried many. No. They know it. They know they want to be better, but sometimes they hold themselves back. It’s not a big deal. “

Ironically, some patients often become their own worst advocates when in the office if they want to downplay the severity of their condition. The lesser way is to give them what they want. This is another topical drug. But what they really want is to get better.

Michael Cameron, MD, FAAD: I couldn’t agree more. I think people with atopy are getting used to their skin. They are devastated and think this is the way they are and the only way they can live. They don’t remember itching. I have countless Dupixent patients who have persuaded me to seek treatment. they will always thank me I see him every 6 or 12 months and each time he says: I thought this was the only way I could live. They come to think of it as a part of themselves, as opposed to being as symptomless as people with psoriasis. They don’t consider it part. They want to get rid of it immediately. That’s a great point.

Brian Keegan, M.D.: You talked about itch and how it can be intimidating in their lives. Like me, you’ve probably participated in clinical trials. The patient calls back a few days after trying the new drug, realizing that for the first time in his life itching is gone. So how do we help our patients? Sometimes we help them understand the seriousness of their condition and how much it affects their lives. It may take another 30 seconds to dig into the . how do people sleep If you’re an adult patient, do you sleep in a separate bedroom from your significant other? .

Casey Butrus, PharmD: Some patients may not know what itch relief is like until they experience these new treatments. Atopic dermatitis is intended for moderate to severe conditions in which patients have had an inadequate response to topical therapy or are not candidates for topical therapy. That’s interesting. If you have sensitive skin, it may not be the best candidate for topical therapy.

Amy, I’m curious about your perspective as a biological coordinator. When reviewing previous approvals, were payers aware that payers had the means to allow exceptions where these local therapies might not be recommended under the tiered therapy criteria?

Amy Brennan: That’s a great point. This is key to what we’ve been discussing about asking the patient leading questions, because body surface area isn’t everything. Clear documentation should be provided for each patient. This includes the nuances of a patient’s case and why they feel they need the drug, no matter what their payer formulary is. And it varies from payer to payer.

Knowing what the coverage standards and labels of the medicines themselves are is key to advocating patients to payers. It then says, “They are uncontrolled. This is how they show they are uncontrolled. The label says they should be moderate to severe. These are: A scale of moderate to severe, which we consider to be controlled by local therapy. ” Creating documentation is a big part of this process. Explain to your insurance company why you would choose one drug over another.

Brian Keegan, M.D.: your point is great. To balance out for the slightly worried prescribers, as much as they help you with the documentation, it doesn’t have to be a ton, a sentence or two is all we’re talking about. You don’t have to write paragraphs and paragraphs about what you need. One more sentence or two about how it affects the fact that you can’t concentrate at school, or work, or the fact that other people in your family can’t sleep at night? has become a proof. You don’t need more than that, but a little is enough.

Amy Brennan: absolutely.

Casey Butrus, PharmD: We are trying to understand the scenarios and exceptions that occur from the payer’s perspective, but they may be more common than the rare exceptions. . If topical corticosteroids or topical calcineurin inhibitors are needed, which patients will not be candidates for it? How can we accommodate them so that they are not refused? You may have to go through a process.

Edited transcript for clarity.

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