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Dupilumab approved for use in eczema patients in Singapore, but treatment is costly

Joyce Teo on 30 Jun 2019

The Straits Times


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SINGAPORE - A newly approved first-of-its-kind biologic drug may bring hope to patients who are having a hard time bringing their moderate to severe atopic eczema under control.


Some patients at both public and private institutions, including adolescents, have been treated with the newly available Dupilumab, sold under the brand name Dupixent, which has been shown to be relatively safe and effective in international trials that included Singapore. The Health Sciences Authority approved its use in adult patients about two months ago.


Atopic dermatitis, also known as atopic eczema, is the most common form of eczema, a skin inflammation characterised by a red, inflamed and itchy rash. About 10 to 11 per cent of the adult population in Singapore are estimated to have atopic eczema. At the National Skin Centre (NSC), new eczema cases numbered 10,086 last year, up from 9,406 cases in 2008.


"Given that there have been no significant breakthroughs in the management of this condition for the past few decades, this new option can make a significant impact," says Dr Mark Tang, a dermatologist at The Skin Specialists & Laser Clinic, who was involved in the research on Dupilumab when he was head of the Eczema Clinic at NSC.


Agreeing, Dr Tan Kian Teo, a dermatologist with Skin Physicians, says: "For a long time, we had only topical steroids, calcineurin inhibitors, phototherapy and systemic immunosuppressants (which potentially have a lot of side effects)."


In Dupilumab trials, more than a third of patients who received treatment achieved clear to almost clear skin after four months, he notes.


Dr Yew Yik Weng, a consultant at NSC, says that about 70 per cent of patients treated with the drug achieved a 75 per cent improvement of their atopic eczema after four months of treatment, when it is combined with the use of emollients and topicals. NSC was part of the multi-sites international Dupilumab trials.


Treatment effects can be seen as early as after one month and experts generally recommend patients be treated for at least four months, he said.


Users should watch out for eye irritation or conjunctivitis, says Dr Yew, but he adds that the drug is generally well tolerated.


The main problem is the cost as Dupixent costs more than $2,000 a month. There is no subsidy currently for this treatment.


The drug, which is neither a steroid nor a conventional immunosuppressant, is given by injection every other week.


It was approved for use in adult patients in the United States in 2017 and in the European Union and Japan last year. And, in March this year, the US approved it for use in adolescents, aged 12 to 17, who have moderate to severe eczema.


In Singapore, KK Women's and Children's Hospital has started using Dupilumab in adolescents with eczema, says its head of dermatology service and senior consultant, Associate Professor Mark Koh.


Dupilumab is not approved for use on children below 12 or pregnant women.


There are other biologic treatments for atopic eczema that are undergoing research. Unlike conventional drugs, which are typically manufactured through chemical synthesis, biologics are manufactured in a living system such as a micro-organism, or plant or animal cells.


Dupilumab works by targeting a part of the immune system thought to contribute to the symptoms of moderate to severe eczema. By reducing the inflammation, it soothes the skin redness, itch, and rash associated with the disease.


Treatment can help improve a patient's quality of life as many are known to suffer from anxiety, depression and low self-esteem.


"Severe atopic dermatitis is now considered a systemic condition, rather than just a skin condition," says Dr Tang.


There is evidence that the inflammation in the blood affects other organ systems such as the lungs, nasal airways and even the brain, he says.


"There is also an association with metabolic diseases such as hypertension and obesity," he adds. "And, of course, the psychological impact is tremendous, leading to depression and anxiety in many patients."


Source: The Straits Times © Singapore Press Holdings Limited. Reproduced with permission.



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