“VERY INTERESTING” This was the often used comment by Arte Johnson on the decades old ‘Laugh In’ show on NBC television. He played a German spy or professor with a strong German accent and used this comment when things appeared very peculiar to him. I repeat the same comment when I quote a Dr Andrew Blauvelt talking at a European dermatology conference and stating that “Dupilumab displayed consistently strong efficacy across all patient groups in a new analysis from the Landmark 52 week CHRONOS trial.” “Dupilumab with concomitant topical corticosteroids improved signs and symptoms of atopic dermatitis compared with placebo injections regardless of age, sex, BMI, or prior history of asthma, allergic rhinitis or food allergies.” “Indeed, he quiped, that the biologic proved to be boring in its broad effectiveness.” VERY INTERESTING says Rapaport. 1. Why are all the patients still on steroids if this is a wonder drug? This is a very poorly organized protocol – in fact outrageous compared to well done studies in the past. 2. What does he mean by strong efficacy? – that always meant to me that it didn’t do very much in bettering the disease. 3. What does he mean by broad effectiveness? – again another exceptionally vague term.
Dupilumab – Hocum
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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.