🌿 Atopic Dermatitis: Approach to Introducing Biologics (Injectable Medications)

- When do we start? When can we stop? What's the relapse rate?

Atopic dermatitis is a “constitutional disease” characterized by a weakened skin barrier that makes the skin prone to persistent inflammation.
Therefore, there are "waves" that go back and forth between improving and worsening.

In recent years, with the advent of biologics (such as dupilumab),
We have entered an era where difficult symptoms can be effectively suppressed, greatly improving quality of life.
Here's how to think about introducing biologics, and
This will clearly summarize "When you can quit" and "What happens after you quit."

🩺 When should I consider biologics?

Biologics may be an option in the following cases.

• Insufficient improvement even with proper use of topical medications (steroids, Protopic, Corectim, etc.)
• My itching and eczema are interfering with my sleep, school, and work.
• Even when the skin improves, it relapses quickly.
• There are areas like the face and neck where it's difficult to control symptoms with topical medications alone.
• Suffering from multiple allergic diseases such as asthma and nasal allergies.

Biologics are
"The next step for those who find it difficult to control their condition with topical medications alone"
is positioned as

🌈 Biologics are not a “start and continue for life” medication.

Common anxieties include
Once you start, you won't be able to stop, will you?
There are voices saying this.
Medically speaking,
“There is no data that says you must do it for the rest of your life.

However, atopy is a constitutional disease, so
A certain number of people experience recurrence after stopping treatment.This is also true.

🔄 3. How many people relapse? (Relapse rate)
In current research,
After stopping biologic therapy
Approximately 20-40% of people relapse within 1-2 years.It is reported that.

This is,
Worsened by medication
Rather than
The original atopic constitution is returning.
This is a natural progression.
If it recurs,
If it resumes, many people will get better again.

⏳ 4. When can I stop? How do I stop?

There is no clear "stopping point" decided, but
Consider reducing or stopping in the following cases.
The skin condition is good enough and has been stable for several months.
The patient themselves wants to reduce or quit.
Side effects, desire to become pregnant, and other life events

The basic way to quit is "little by little."
Instead of canceling suddenly,
Every 2 weeks → Every 3 weeks → Every 4 weeks
etc.How to gradually extend the dosing intervalalso available
In the meantime,
It's important to continue using topical medications and moisturizing diligently.between 27 and 36 weeks of pregnancy.

💡 5. Who can be maintained with topical medications alone?
After stopping biologic drugs,
Currently, only a small minority (around a few percent) can achieve long-term stability with topical treatments alone.
It has been reported.
Especially for those with moderate to severe symptoms,
Maintenance with external medication alone is often difficult.

💴 6. High-cost medical expenses

Biologics are an expensive treatment, but
Medical Assistance for Persons with Disabilities (Severe Cases)
High-cost medical expense benefit system, pediatric medical expense subsidy
etc.Public support systems may be available.
Also, once the condition stabilizes,
Reduce costs by extending the dosing intervalIt is also possible.

🌟 Summary: Biologics are “medications to regain control”

in consultation with a doctor“An era of adjusting ”use, reduce, and rest."
Biologics are powerful treatments that suppress the atopic constitution itself.
You don't have to keep doing it forever if you start.
However, there are a certain number of people who will relapse if they stop.
Even if it recurs, if you restart, many people will improve again.
It seems there are ways to reduce costs, such as extending the dosing interval.

References

1. Japanese Dermatological Association Guidelines for the Management of Atopic Dermatitis
   Japanese Dermatological Association. Latest Edition.
2. American Academy of Dermatology (AAD) Guidelines for the Management of Atopic Dermatitis
   Davis DMR, Drucker AM, et al. Journal of the American Academy of Dermatology.
3. Atopic Dermatitis: Pathogenesis and Treatment
   Guttman-Yassky E, Renert-Yuval Y, Brunner PM. Lancet.
4. Biologics for Atopic Dermatitis: Efficacy, Safety, and Long-Term Outcomes
   de Bruin-Weller MS, Boesjes CM, et al. Allergy.
5. Dupilumab in Moderate-to-Severe Atopic Dermatitis: Long-Term Safety and Effectiveness
   Beck LA, Bissonnette R, et al. JAMA Dermatology.
6. Real-World Evidence of Dupilumab and Other Biologics in Atopic Dermatitis
   Halling AS, Loft N, Silverberg JI, et al. Journal of the American Academy of Dermatology.
7. Atopic Dermatitis in Children: Natural Course and Management
   Abuabara K, Langan SM. British Journal of Dermatology.
8. FDA Biologics License Information (Dupilumab, etc.)
   U.S. Food and Drug Administration.