Dupilumab FDA Approved for Treatment of Atopic Dermatitis

The FDA granted approval to dupilumab (Dupixent) injection from Sanofi and Regeneron Pharmaceuticals, for the treatment of adults with moderate-to-severe atopic dermatitis (AD) whose disease is not adequately controlled with topical prescription therapies, or the therapies are not advisable.

Dupilumab is a human monoclonal antibody, designed to specifically inhibit overactive signaling of the proteins IL-4 and IL-13, according to a press release. These key proteins are believed to be major drivers of the underlying inflammation in AD.

“People with moderate-to severe atopic dermatitis cope with intense, sometimes unbearable symptoms that can impact them for most of their lives,” Julie Block, president and CEO of the National Eczema Association, said in a release. “To date, there have been few options available to treat people with moderate-to-severe atopic dermatitis who have uncontrolled disease. That's why today's approval of Dupixent is so important for our community. Now we have a treatment that is expected to help address patients suffering from this devastating disease.”

The approval is based on data from the global LIBERTY AD clinical program, which is comprised of 3, randomized phase 3 pivotal trials SOLO 1, SOLO 2, and CHRONOS. The studies examined the use of dupilumab either alone or in combination with topical corticosteroids in patients with moderate-to-severe AD.

In all 3 studies, dupilumab alone or in combination with topical corticosteroids met the primary and key secondary endpoints, according to the press release.

Patients treated with dupilumab monotherapy in the SOLO 1 and SOLO 2 studies experienced improvement in measures of skin clearing and overall extent and severity of disease.

At 16 weeks, 38% of patients in the SOLO 1 trial and 36% in the SOLO 2 trial who received 300 mg of dupilumab every 2 weeks achieved clear or almost clear skin—–measured by the 5-point Investigator’s Global Assessment scale––compared with 10% and 9% with placebo, respectively.

In the same trials at 16 weeks, 51 and 44% of patients, respectively, who received 300 mg of dupilumab every 2 weeks achieved a 75% or greater reduction in the Eczema Area and Severity Index Score (EASI-75) from baseline (key secondary endpoint) compared with 15% and 12% with placebo.

Furthermore, 41% and 36% of patients who received 300 mg of dupilumab every 2 weeks achieved a greater than or equal to 4-point improvement in the daily intensity of patient-reported itch—–measured by the Pruritus Numerical Rating Scale (NRS)––compared to 12% and 10% with placebo.

In the CHRONOS study, patients treated with dupilumab plus topical corticosteroids (TCS) significantly improved measures of overall disease severity at 16 and 52 weeks, when compared with placebo plus TCS.

At 16 weeks, 39% of patients who received 300 mg of dupilumab every 2 weeks with TCS achieved clear or almost clear skin compared with 12% of patients receiving placebo plus TCS. Sixty-nine percent of patients achieved EASI-75 compared with 23% of patients who received placebo plus TCS.

Furthermore, 59% of patients who received 300 mg of dupilumab every 2 weeks with TCS achieved a greater than or equal to 4-point improvement in the daily intensity of patient-reported itch, compared with 20% of patients who received placebo plus TCS.

The CHRONOS study also met additional key secondary endpoints at 52 weeks, demonstrating that 36% of patients who received 300 mg of dupilumab every 2 weeks with TCS achieved clear or almost clear skin, compared with 13% of patients receiving placebo with TCS.

The most common adverse events greater than or equal to 1% with dupilumab were injection site reactions, eye and eye lid inflammation, including redness, swelling, and itching, and cold sores in the mouth or on the lips.

Dupilumab comes in a pre-filled syringe and can be self-administered as a subcutaneous injection every other week after an initial loading dose. It will be available later this week in the United States, with a wholesale acquisition cost (WAC) of $37,000 per year. The actual cost of dupilumab to patients, payers, and health systems are expected to be lower because WAC pricing does not reflect rebates, discounts, or patient assistance programs.

Reference

Sanofi and Regeneron announce FDA approval of Dupixent (dupilumab), the first targeted biologic therapy for adults with moderate-to-severe atopic dermatitis [news release]. New Jersey. Sanofi’s website. http://www.news.sanofi.us/2017-03-28-Sanofi-and-Regeneron-Announce-FDA-Approval-of-Dupixent-R-dupilumab-the-First-Targeted-Biologic-Therapy-for-Adults-with-Moderate-to-Severe-Atopic-Dermatitis. Accessed Mar. 28, 2017.