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Dermbits

Have you combined dupilumab with any other systemic anti-inflammatories for partial responders to dupilumab?

Atopic Dermatitis

Yes. And again, Vivian, she and I wrote a paper about this that was kind of fun to think through, because I do get patients where they're better. They're certainly better, but they're not where they need to be. So we would call this. Right, a partial responder or maybe a non durable responder. Maybe. They started out pretty well, but now it seems to be not working like it used to. Absolutely. So I do a number of different things. I would consider, of course, always going back to the diagnosis. Could they have something else going on? Do they have an infection? Do they have a concomitant allergic contact dermatitis? Is there something we're missing with this patient? So we could start there? If we don't think there is, then we could say, could we do something simple like phototherapy? Can we maximize our topicals? Are we doing that? And then, if not, then I have added low dose methotrexate, low dose cyclosporin. I really try to avoid systemic corticosteroids, because I just feel that they're a deal with the devil in many patients. They do great. They love you. But until they don't, until you're off of it, now you're actually worse than where you started. And now we, of course, have an option that's sort of even beyond the biologics. So if they really didn't do well enough and we couldn't do any of these other things, I might switch them to an oral jack inhibitor. And if you look at the labeling, of course, the oral jack inhibitors even specifically say for patients who have tried another systemic agent, including the biologics.