Harvard Health Ad Watch: A new injection treatment for eczema
An advertisement for a new neurodermatitis drug leaves a few questions unanswered.
Dry, itchy, red skin is the hallmark of eczema. If you have eczema and saw this ad, you may be wondering about Dupixent (dupilumab). Does this new drug work as well as advertised? Where does the ad hit the mark and where could it be better?
The medicine only treats one type of eczema
While the ad uses “eczema” and “atopic dermatitis” interchangeably, these conditions aren’t exactly the same. Eczema is an umbrella term that includes:
- atopic dermatitis, which occurs in people prone to asthma and environmental allergies such as hay fever
- Contact dermatitis, which is an allergic reaction to a substance that touches the skin, such as soaps, fragrance products, or poison ivy
- Skin inflammation associated with leg swelling.
Atopic dermatitis is the only skin condition for which Dupixent is approved.
Every ad is a selling point, whether it features real people or paid actors. Here we see real people banging drums in a band, playing the piano or trombone and baking in the kitchen. A voiceover says, “With less eczema, you can show more skin. So roll up your sleeves and help heal your skin from within with Dupixent.” The pitch? People with eczema can feel embarrassed about it and try to hide it — and effective treatment means you don’t have to cover your skin.
Next we hear that this is “the first treatment of its kind that treats moderate to severe eczema or atopic dermatitis continuously, even between flare-ups.” The viewer sees an outstretched arm with a red rash that clears up after a second or two. Of course, that doesn’t happen in real life; It can take weeks to see improvement.
Even more confusing is that the voiceover tells us that the drug is “…a biologic and not a cream or a steroid.” You may be wondering what “biological” medicine is. Keep this question below for further explanation. “Many people who took Dupixent saw clear or almost clear skin and felt significantly less itching. That’s a difference you can feel.“
Side Effects, Warnings and a Slogan
The warnings may raise eyebrows. “Do not use if you are allergic to Dupixent. Serious allergic reactions can occur, including anaphylaxis, which is severe. Tell your doctor about new or worsening eye problems, such as eye pain or blurred vision, or parasitic infections. If you are taking asthma medication, change or do not stop taking them without talking to your doctor.“
However, the ad quickly transitions to a glowing slogan: “So help your skin heal from the inside out” and recommends speaking to “your eczema specialist” about Dupixent. This can be difficult: Most people with neurodermatitis go to their family doctor for this, not a dermatologist.
What the ad does right
It’s true that people with eczema try to hide it, and effective therapy can be liberating, allowing them to worry less about others seeing their skin. In fact, Dupixent is neither a cream nor a steroid, which are older, more common treatments for eczema. And yes, Dupixent is the first treatment of its kind for eczema. It blocks a chemical called interleukin 4 (IL-4), which is thought to play an important role in this skin condition.
What else should you watch out for with neurodermatitis?
- How is it usually treated? Mild cases of atopic dermatitis may respond to skin moisturizers or medicated creams, gels, or ointments, some of which contain steroids. However, this may not be effective for more severe eczema.
- What is a biologic? These drugs are manufactured in a living system such as a microorganism, human or animal cells, or plant cells. They are often antibodies that block a substance in the body that is thought to cause or contribute to a disease. Because biologics are usually large molecules that would be destroyed during digestion if taken in pill form, they are generally only available by injection. Dupixent is injected every two weeks.
- Why are eye problems, parasites and asthma mentioned in the warnings? In studies that led to approval, eye inflammation was a side effect of the drug. IL-4 is thought to be a key element in our immune defenses against parasitic infections, and some study participants developed parasitic infections. For asthma, Dupixent is an approved treatment for asthma in combination with other medicines. So if you’ve had asthma and it got better while treating your atopic dermatitis, you might be tempted to reduce your other medications — but that’s not safe without medical supervision.
- what about the cost Biologics are expensive. This annual price for this drug is around $40,000 per year. Even when covered by health insurance, co-payments and deductibles can make treatment a costly affair.
- It works? The text that appears on the screen says that 37% of adults and 24% of teenagers saw a significant improvement after four months of treatment, compared with less than 10% of people not taking Dupixent. That might seem great when you’re in the minority of people who have improved dramatically. Or it may seem like a modest success for a systemic treatment with a significant risk of side effects and a high price tag.
The final result
Drug ads exist to sell a product. They should never be your primary source of health and treatment information. To do this, consult your own healthcare providers and other reliable sources of information such as the FDA or NIH. Their primary interest is to provide accurate information and to promote public health and drug safety, not persuade you to use a particular drug.