Dr Matthew J. Zirwas on Communicating About AD Treatment Persistence

Patients often ask how long they have to stay on biologic treatment for atopic dermatitis (AD), but there is a risk if therapy is stopped, says Matthew J. Zirwas, MD, a dermatologist in Ohio.

Transcript

What sort of patient education is needed when it comes to communicating about being adherent and persistent with atopic dermatitis treatment?

It's actually one of the things that becomes really interesting to me around talking about dupilumab has been that patients, even more so than with psoriasis, say, “Well, okay, if it works, and I get better, how long do I have to stay on it?”

And really, my answer to them is, look, you really should stay on it indefinitely. Because again, we know that the dupilumab protects you from infections. And when your dermatitis becomes active, that's when you're at risk for infection. So yeah, maybe we can take you off dupilumab and maybe you'll be fine for 6 months or a year. But it's essentially a certainty that at some point you're going to flare again. If we take you off of the dupilumab, we can put your back on it if that happens. But each time that happens, you're putting yourself at risk for serious infections; [again] getting patients to understand that it's not just a quality of life issue, because if it's just a quality of life issue, it's reasonable if a patient says, “I don't really want to take these shots, I'd rather just not have to take the shots for six months. And when my eczema comes back, then I'll start them back up.” If it's purely a quality of life issue, that makes total and complete sense. But when it's a safety issue, where that flare puts you at risk, that it really changes that calculation, some. And so that's kind of the biggest patient education aspect of it, is getting people to realize it's not just their comfort, where they might say, “Well, I'm willing to put up with a flare so that I can stop the shots.” They're really putting themselves at risk if they do that.