Zitter Pulse Check: Atopic Dermatitis

Coverage

Atopic dermatitis is a high-cost category with an increasing number of therapies that treat the condition. To help stakeholders absorb datapoints and perceptions from all directions and synthesize those insights into a tangible strategy for atopic dermatitis, Zitter Insights surveys a leading panel of pharmacy and therapeutics (P&T) decision makers at payers and integrated delivery networks. The Managed Care Biologics and Injectables Index combines deep payer insights with the industry standard in market access information to produce quarterly reports and insights summaries on leading specialty brands.

Preferred Therapies

More than 25 million people in the United States suffer from atopic dermatitis, which is the most common form of eczema. Commercial payers with almost half of covered lives say that the calcineurin inhibitor cream Elidel (pimecrolimus) from Bausch Health Companies Inc. is their most ideal first-line therapy for the condition (see chart). Another calcineurin inhibitor cream, Protopic (tacrolimus) from Astellas Pharma US, Inc., is the preferred second-line therapy among commercial payers.

Among dermatologists, however, the monoclonal antibody Dupixent (dupilumab) from Sanofi and Regeneron Pharmaceuticals, Inc. is their preferred first-line agent, while Protopic is their ideal second-line treatment. The drugs that dermatologists prescribe most often are Dupixent, Pfizer Inc.’s phosphodiesterase 4 inhibitor Eucrisa (crisaborole), Protopic and Elidel.

Key Findings

Contracting

Commercial payers with almost three-fourths of covered lives expect to maintain or increase preferential utilization contracting within the atopic dermatitis class. Most common are rebate-based agreements; commercial payers with more than two-thirds of lives anticipate they will maintain or increase these deals, while Medicare payers with more than 90% of lives expect to take the same action. Indication-based and portfolio-based arrangements are somewhat common, but market-share/volumebased deals are entered into less often.

Drug Pipeline

Multiple agents are in the late-stage pipeline for atopic dermatitis. Commercial payers with more than three-fourths of lives are interested in AbbVie Inc.’s Janus kinase (JAK) inhibitor Rinvoq (upadacitinib), which already has FDA approval to treat adults with moderately to severely active rheumatoid arthritis (see chart). Almost two-thirds of dermatologists are very interested in another JAK inhibitor, Incyte Corp.’s ruxolitinib cream, which is already on the market in tablet form as Jakafi.

Tralokinumab

On April 30, 2021, the FDA issued a Complete Response Letter for LEO Pharma Inc.’s interleukin-13 agent tralokinumab for the treatment of moderate to severe atopic dermatitis. The manufacturer said the agency had requested additional data on a device component but did not have questions about the therapy’s clinical efficacy or safety. About two-thirds of rheumatologists expect that they will prescribe the agent. Payers covering more than 40% of lives expect to manage the drug more restrictively than its FDA-approved label.

Trends

Safety & Efficacy

Message: “Eucrisa is not a steroid. This works on a different enzyme inhibition. Did state it can also be used for adults and kids on almost all parts of the body. Also has no fragrance and minimal if any side effects. Many members can see dramatic improvement by 30 days of use. Did state that some patients could see improvement in a little as seven days.”

Payer Thoughts: “Impressive results of almost clear skin by 30 days.”

Dupixent Gains Share in Atopic Dermatitis

Dupixent (dupilumab), the first biologic approved for atopic dermatitis (AD), hasn’t shaken up treatment of the condition completely even as it steadily gains market share, since the bulk of plans still require patients to try mostly generic topical corticosteroids and topical calcineurin inhibitors first. But more competition could be coming to this category, with the FDA set to consider four new products for AD, including three Janus kinase (JAK) inhibitors.

Subscribers to AIS’s RADAR on Drug Benefits may read the in-depth article online

FDA Approves Dupixent Prefilled Pen

On June 16, 2021, the FDA expanded the label of Sanofi and Regeneron Pharmaceuticals, Inc.’s Dupixent (dupilumab) to include a 200 mg single-dose prefilled pen for use in people at least 12 years old for the treatment of atopic dermatitis, asthma and chronic rhinosinusitis with nasal polyps. A 300-mg single dose pen was approved July 19, 2020.

Subscribers to AIS’s RADAR on Specialty Pharmacy may read the in-depth article online

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