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Dermbits

Would you consider using ruxolitinib instead of TCS with a patient on dupilumab for breakthrough flares?

Atopic Dermatitis

You? Absolutely. I think that topical roxylitinib is really exciting. It's one of our new treatments in our armamentarium. And in my experience so far, it has been really on par with, in some situations, even better than topical steroids, which is really saying something for a non steroidal agent, because typically and historically, we felt like for non topical steroids, we have to take little bit of. We have to take a compromise and we say, well, it's not a steroid. And so we get some safety, but we trade a little bit of efficacy with topical rucks. I feel like there is very, very little trade off. It's pretty amazing. Now, there is some safety issues and this is a problem. Of course, we have to make sure we talk to our patients about it. And I think it's very difficult for me as a clinician to frame it, because part of me wants to just dismiss it and say, well, don't worry, it's just the topical version. We give people the oral. But I don't think that. Correct. I think we have to address it and say, yes, there is theoretical risk of major adverse cardiovascular event and, of course, blood clots and all of these other aspects that come with it. And this is tricky because a patient then starts blanching and saying, well, are these real? What do I have to do about this? And so we don't know. But I think, most importantly, what we can say to patients about this is that in general, the patients who are using it for atopic dermatitis and using it appropriately, less than 20% body surface area, not longer than eight weeks at a time, intermittent use, they generally did very, very well. So when you look at the specific data in ad, it's quite reassuring. But yes, there is a black box warning, and that's really a class warning that I think is important about jack inhibitors in general. And again, they could apply in certain situations, but I think that's the right way to frame it, at least for my patients. And they understand it, they get it, they understand why, but then they think they feel comfortable using it. Now, that being said, I think it's quite safe to use along with topiliumab, and I have used it that way. But I will say that I've had a couple of insurance companies push back on me and say, no, these can't be used together. They shouldn't be used together. And it's interesting, there's not a specific, direct contraindication about that. I think part of it is that it's unknown. They haven't been studied together. And part of it is that they're both really, really expensive. So to put these two medicines together is quite expensive. But for the right patient, I do think it's worth fighting for and saying, listen, they failed topical storage calcium inhibitors. They've also failed our topical phosphodiase four inhibitor. We have no other options, and they're doing fairly well, but they have some troublesome areas. So can I please try this? And in that context, or. I've tried it, I've given them samples, and they're really doing well, then I've been able to get it covered. Hopefully that will continue because I think it is a really important therapeutic modality.