Skin Disorders
Pharmacy/Prescription Drugs

Diagnosis: atopic dermatitis
Treatment: Dupixent
The insurer denied Dupixent. The health plan's determination is overturned.

The patient is a male with atopic dermatitis, treated with topicals including steroids, Eucrisa and topical calcineurin inhibitors, phototherapy and cyclosporine. The provider requesting Dupixent.

Dupixent is medically necessary for this patient.
Dupixent is United States Food and Drug Administration indicated for treatment of recalcitrant atopic dermatitis and can potentially make a significant impact of this patient's life. Dupixent is a novel interleukin-4 and interleukin-13 blocker, which inhibits the arm of the immune system responsible for atopic dermatitis. In clinical trials, after 12 weeks of monotherapy with Dupixent, 85% of patients had a greater than 50% reduction in eczema severity and pruritus scores decreased by 57.1%. In phase III clinical trials, Dupixent led to a 75% improvement in eczema severity, when compared to placebo, and decreased symptoms of anxiety and depression. It also led to a significantly decreased use of topical corticosteroids. The safety and efficacy were supported in a recent meta-analysis of all published Dupixent paper.
This patient has tried and failed all other appropriate therapies for atopic dermatitis. The patient has already tried cyclosporine and phototherapy. Methotrexate and azathioprine should be avoided in males of childbearing potential. Dupixent is FDA approved for this condition and is the next logical therapeutic option for this patient.