Utilization Insights for Dupilumab
Jenny Murase, MD, is Associate Clinical Professor of Dermatology at the University of California, San Francisco (UCSF) and Director of Medical Consultative Dermatology, Palo Alto Medical Foundation in Mountain View, California. A founding member of the AAD Women’s Health Resource Group and co-editor in Chief of the International Journal of Women’s Dermatology, she has authored or co-authored more than 147 book chapters and peer-reviewed articles in addition to delivering more than 210 regional, national, and international presentations on topics in the field of medical dermatology.
Transcript
In your recent February 2021 study1 you found that dupilumab was efficient in the treating brachioradial pruritus which is noted as an uncommon neuropathic dysesthesia mainly observed by middle-aged women. What other disease states can dupilumab be utilized for that can benefit women?
Dupilumab is approved for atopic dermatitis in dermatology. It's also used for asthma as well as well chronic rhinosinusitis. Within dermatology, we are seeing off label uses of the medication, and there is literature to support its use in alopecia areata, which is a form of hair loss, urticaria, which would be hives, and bullous pemphigoid, which an autoimmune disease in the elderly.
Also, there have been reports of it being used—and I've actually personally seen the use of dupilumab, because I've used it in my patients—for prurigo nodularis, which is a chronic itching condition of bumps on the skin, as well as for a hand dermatitis, when allergic contact dermatitis has been ruled out through patch testing.
I have a case that I published within the International Journal of Women's Dermatology2 of a case of pruritus ani, where a patient was patch tested. All allergens were removed, and many neuropathic antipruritic medications were used. It was ultimately dupilumab that was the therapy that improved this patient. Pruritus ani, itching around the anus, is another potential off label usage of the medication.
In addition, within elderly patients, there is a condition that has been called multiple names over the years. Some have called it just itchy red bump disease in the elderly. It can be called subacute prurigo.
Grover's disease presents when you biopsy as a transient acantholytic dermatitis. There’s actually a subset of patients that were published out of UCSF by doctors Berger and Butler3 that looked at use of dupilumab in grover's disease specifically.
This itchy red bump disease of the elderly has also been referred to eruption of immunosenescence, implying that, over time, your immune system becomes more allergic. You can create these itchy red bumps in the skin.
Most recently, we have a publication in the British Journal of Dermatology4 that refers to this condition as immunologic eruption of aging. We refer to it as IEA, so that we're taking all of these terms that have been used over the years and giving it a single name and defining it, so that it can better studied.
I do have patients with this IEA, this immunologic eruption of aging, this itchy red bump disease, that have responded to dupilumab. Whenever the allergic arm of the immune system is revved up, it's a medication that could potentially be used.
Read more of Dr Jenny Murase's insights into dupilumab here.
Reference
1. Abel MK, Ashbaugh AG, Stone HF, Murase JE. The use of dupilumab for the treatment of recalcitrant brachioradial pruritus. JAAD Case Rep. Published online February 17, 2021;10:69-71. doi:10.1016/j.jdcr.2021.02.005
2. Yang EJ, Murase JE. Recalcitrant anal and genital pruritus treated with dupilumab. Int J Womens Dermatol. Published online October 4, 2018;4(4):223-226. doi:10.1016/j.ijwd.2018.08.010
3. Butler DC, Kollhoff A, Berger T. Treatment of Grover Disease With Dupilumab. JAMA Dermatol. 2021;157(3):353-356. doi:10.1001/jamadermatol.2020.5097
4. Abel MK, Jelousi S, Berger T, Murase JE, Butler DC. Immunologic Eruptions of Aging: Reframing Chronic Pruritic Rashes in Older Adults. Br J Dermatol. Published online April 29, 2021;10.1111/bjd.20414. doi:10.1111/bjd.20414
