People’s Pharmacy: Doctor endorses Dupixent for eczema
Q. In a recent article about the challenges of treating eczema (atopic dermatitis), you described a number of over-the-counter treatments as well as modern prescription medicines. In particular, you described serious side effects associated with Rinvoq such as susceptibility to infections, cancer, heart attacks and strokes.
However, you did not mention another important medication, dupilumab (Dupixent). This drug offers significant benefit for patients with severe atopic dermatitis that hasn’t responded to comprehensive management. It does not cause the potentially significant side effects associated with Rinvoq.
Omitting Dupixent from your discussion implies that people with this debilitating disease don’t have options other than Rinvoq. I am basing my comments on published studies as well as my clinical experience treating patients with severe eczema. Please correct this oversight.
A. Initial treatment of eczema includes strong moisturizers as well as corticosteroid creams. Topical immunosuppressing drugs, especially tacrolimus or pimecrolimus, might be the next step. You refer to people who have not responded to this kind of comprehensive management.
Dupilumab is a monoclonal antibody that blocks some important immune system signaling molecules (interleukin-4 and IL-13). In clinical trials submitted to the Food and Drug Administration, 35% to 50% of patients with moderate-to-severe atopic dermatitis got significant benefit. Forty to 60% had important reductions in itching. Those results are significantly better than the placebo response.
Side effects of Dupixent include eye problems such as conjunctivitis, dry eye and itching eyes. People taking Dupixent are also more susceptible to herpes infections. They may also suffer muscle pain or joint pain, which can be severe. We trust that you and other doctors prescribing Dupixent review these possible responses with patients ahead of time.
Q. I have been taking zolpidem for at least ten years. I have no side effects that I know of. I tried getting off but just cannot. However, I would like to know if there are any long-term consequences, like cancer, I should be aware of.
I’m slowly trying to cut back by using GABA and melatonin. Do you have any other recommendations?
A. Doctors are still debating whether long-term zolpidem (Ambien) use might increase the risk for cognitive difficulties (Experimental Gerontology, July 15, 2020). Falls and fractures might be more of a hazard over the years.
GABA (gamma-aminobutyric acid) and melatonin are both produced in the brain. Drugs that work through GABA don’t appear very helpful for insomnia (BMJ, Nov. 18, 2022). A recent systematic review and meta-analysis of melatonin found that it may be helpful for children and adolescents with chronic insomnia (Sleep Medicine Reviews, December 2022). For adults, however, this dietary supplement was not very effective.
You can learn about herbal remedies for insomnia in our “eGuide to Getting a Good Night’s Sleep.” This online resource may be found under the Health eGuides tab at www.PeoplesPharmacy.com.
Q. I have blepharitis, which makes my eyelids red and itchy. I used baby shampoo and hot compresses, per doctor’s order, for about 10 years. Then, a different eye doctor recommended OCuSOFT Lid Scrub original cleanser. I love it! It’s so much easier to use than all that other stuff.
A. OCuSOFT Lid Scrub contains several gentle detergents to remove oil and debris from the eyelids. Although there is no “house brand,” Systane also makes an eyelid cleanser.
In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”