Harvard Health Ad Watch: A new injection treatment for eczema

Dry, itchy, reddened skin is the hallmark of eczema. If you have eczema and have seen this ad, you may be wondering about Dupixent (dupilumab). Does this new medicine work as well as it seems to in the ad? Where does the ad hit the mark, and where could it do better?

The medicine only treats one type of eczema

While the ad uses "eczema" and "atopic dermatitis" interchangeably, these conditions aren't exactly the same. Eczema is an umbrella term that includes:

• atopic dermatitis, which develops in people prone to asthma and environmental allergies, such as hay fever
• contact dermatitis, which is an allergic reaction to a substance touching the skin, such as soaps, scented products, or poison ivy
• skin inflammation that accompanies leg swelling.

Atopic dermatitis is the only skin condition for which Dupixent is approved.

The pitch

Every ad is a sales pitch, whether it uses real people or paid actors. Here we see real people banging on drums in a band, playing piano or trombone, and baking in the kitchen. A voiceover says "With less eczema, you can show more skin. So, roll up those sleeves and help heal your skin from within with Dupixent." The pitch? People with eczema may be embarrassed by it and try to hide it — and effective treatment means you need not keep your skin covered.

We next hear this is "the first treatment of its kind that continuously treats moderate to severe eczema, or atopic dermatitis, even between flare-ups." The viewer sees an outstretched arm with a red rash that clears up over a second or two. Of course, that's not what happens in real life; it can take weeks to see improvement.

More perplexingly, the voiceover tells us that the drug "…is a biologic, and not a cream or steroid." Perhaps you're wondering what a "biologic" medicine is. Hold that question for further explanation below. "Many people taking Dupixent saw clear or almost clear skin and had significantly less itch. That's a difference you can feel."

Side effects, warnings, and a tagline

The warnings may raise eyebrows. "Don't use if you're allergic to Dupixent. Serious allergic reactions can occur, including anaphylaxis, which is severe. Tell your doctor about new or worsening eye problems such as eye pain or vision changes, or parasitic infection. If you take asthma medicines, don't change or stop them without talking to your doctor."

Quickly, though, the ad moves on to a glowing tagline: "So help heal your skin from within" and recommends talking to "your eczema specialist" about Dupixent. That may be difficult: most people with eczema see their primary care physician for it, not a dermatologist.

What the ad gets right

It's true that people with eczema may try to hide it and that effective therapy may be liberating, allowing them to worry less about others seeing their skin. Dupixent is, indeed, neither a cream nor a steroid, which are older, common treatments for eczema. And, yes, Dupixent is the first treatment of its kind for eczema. It blocks a chemical called interleukin 4 (IL-4), which is thought to play an important role in this skin disease.

What else should you consider if you have atopic dermatitis?

• How is it usually treated? Mild cases of atopic dermatitis may respond to skin moisturizers or medicated creams, gels, or ointments, some of which contain steroids. But this may not be effective for more severe eczema.
• What's a biologic? These medicines are made in a living system such as a microorganism, human or animal cells, or plant cells. They are often antibodies that block a substance in the body thought to cause or contribute to a disease. Because biologics are usually large molecules that would be destroyed during digestion if taken in pill form, they are generally available only by injection. Dupixent is injected every two weeks.
• Why are eye problems, parasites, and asthma mentioned in the warnings? Eye inflammation was a side effect of the medicine in studies leading to approval. IL-4 is considered a key part of our immune defense against parasitic infections, and a few study participants developed parasitic infections. As for asthma, Dupixent is an approved asthma treatment when combined with other medicines. So, if you had asthma and it improved while you treated your atopic dermatitis, you might be tempted to cut back on your other medicines — but that's not safe without medical supervision.
• What about cost? Biologics are expensive. This yearly price tag for this medicine is about $40,000 a year. Even when covered by health insurance, copays and deductibles can make it a costly treatment.
• Does it work? Text appearing on the screen says 37% of adults and 24% of teenagers saw major improvement after four months of treatment, compared with less than 10% of people not taking Dupixent. That may seem great if you're in the minority of people who dramatically improved. Or it might seem like modest success for a systemic treatment with significant risk of side effects and a large price tag.

The bottom line

Drug ads exist to sell a product. They should never be your primary source of health and treatment information. For that, look to your own health care providers and other reliable sources of information like the FDA or NIH. Their primary interest is providing accurate information and promoting public health and medication safety, not convincing you to use a particular drug.