Something is peculiar with the new drug Dupilumab and its marketing. Patient 1 – a moderately symptomatic RSS patient, functioning fairly well, received a near 3 page letter from his dermatologist to take the new ‘wonder drug’ Dupilumab. The letter contained all kinds of compliments for the drug and the doctor has probably had little experience with it since it is a fairly new drug. I read the letter and in reading between the lines it was evident to me that the doctor was going to benefit (rebate ?). I have never seen marketing like this in 40 years of medicine. The 2nd patient, a young woman with a continual red face, addicted for 3 years to steroids, was given ‘free’ a year’s supply of Dupilumab by her doctor. What rebate process went on here? I have never heard of a $37,000 a year drug being given free – again she was ‘induced’ to start the medicine (being not that symptomatic). What is the company gaining? In my experience the results have not been that good.
Prescribing Dupilumab
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About the Author: Dr Marvin Rapaport, MD
In 1978 I initiated and set up the contact and photo dermatitis clinic at UCLA. There was a need to evaluate a large group of patients who exhibited severe eczematoid rashes, especially on the face. Patients were referred from all over Southern California. All patients underwent a lengthy history and examination. Further evaluations included blood studies, allergy patch testing, special sunlight (photo) testing and skin biopsies.
From the start it was apparent that most patients experienced a mild dermatitis on various parts of the body that progressively worsened. Their histories always included numerous doctor visits, multiple physicians, and therapy consisting of an increasing amount of corticosteroids.
My testing failed to reveal any specific culprit chemicals, cosmetics, perfumes, workplace or recreational exposures. It became increasingly clear that the physician’s therapy, the corticosteroids, was invariably causing the problem.
I wrote 7 scientific articles that were published in the most august peer-reviewed dermatologic journals and I gave many lectures at various dermatology meetings. To this day an unfortunate reluctance exists on the part of most physicians to accept this simple concept.
