SEVERE eczema sufferers may soon find relief in a new drug that targets the root of the problem, rather than its symptoms.
Heat, sweat, stress and strong chemicals can bring on an attack of eczema, the common skin condition that often starts in childhood and which, for some, becomes a lifelong affliction.
In an eczema flare-up, the skin turns red, dry, scaly and itchy. Scratching can lead to weeping wounds and infection. As much as 90 per cent of the body can become affected; the sufferer feels unwell, and experiences chills and shivering. Admission to hospital isn’t uncommon when eczema is severe.
Steroid creams and antihistamines are often prescribed to control the inflammation and intense itching. For more severe eczema, treatment aims to control inflammation through immune-modulating treatments such as corticosteroids and cyclosporine, or phototherapy. While effective, the former requires constant monitoring and has potential side effects, while phototherapy with narrow-band UVB light requires patients to visit the hospital two to three times a week, said Dr Lee Haur Yueh, Consultant and Head, Department of Dermatology, Singapore General Hospital (SGH).
But dupilumab, a promising new drug now in the late stages of trial, could significantly relieve the intense itching and other debilitating complications of moderate-to-severe eczema, he said. “When it is approved (by the US Food and Drug Administration, FDA) and becomes available, dupilumab will be a game changer in the treatment of eczema,” said Dr Lee.
SGH is one of three local hospitals – the others are the National University Hospital and the National Skin Centre – participating in the trial. Enrolment in the trial has closed, but participants are continuing to receive treatment, which is by injection every one to two weeks.
According to various reports, the developers of the drug, Regeneron Pharmaceuticals and Sanofi, plan to file for FDA approval soon. Dupilumab acts by blocking interleukin4 (IL4) and interleukin13
(IL13), two small anti-inflammatory proteins secreted by cells that are believed to play a role in eczema. The drug, which the FDA has designated “a breakthrough therapy” to fast-track its development, treats the root cause of the disease rather than its symptoms.
This designation will help bring the drug to market earlier, and was based on positive results from the first two phases of clinical trials.
Regeneron and Sanofi said in June that a one-year phase 3 trial showed that treatment combining dupilumab with anti-inflammatory corticosteroid creams or ointments significantly helped patients suffering from eczema. The trial treatment significantly improved measures of overall disease severity, clearing the skin, reducing itching and improving quality of life through a one-year treatment period, said Dr George Yancopoulos, Chief Scientific Officer, Regeneron, and President, Regeneron Laboratories, in a statement earlier this year.
The study found that 40 per cent of patients who used corticosteroid creams or ointments and received dupilumab weekly, and 36 per cent who received dupilumab every two weeks, enjoyed a clearing or near-clearing of skin lesions at the end of one year. In comparison, 12.5 per cent achieved similar results when using corticosteroid creams or ointments alone.
Despite dupilumab’s fast-track status, it may still take some time before it becomes commercially available. Other drugs that target the signaling pathways involved in skin inflammation in eczema are also on the horizon.
Many people with eczema appear to have a reduced amount of the protein called filaggrin, which helps the skin barrier hold moisture. This deficiency impairs the skin barrier function, making it easier for irritants and allergens to trigger a flare-up.
Eczema is likely caused by a combination of factors, including genetic or environmental factors, the body’s immune response to allergens and other irritants.
Atopic eczema, the most common form of the condition, tends to occur in people who have a tendency to develop allergic diseases, which in addition to atopic eczema, include allergic rhinitis, asthma and allergic conjunctivitis. Eczema is estimated to affect about 20 per cent of people, with 20 per cent of sufferers likely to have the moderate-to-severe form.
• This story was first published in Singapore Health, Sep-Oct 2016 issue.