1. What if my child is afraid of needles?
3. Are there side effects?
4. Can I afford this medication?
5. Will a biologic hamper my child’s immune system?
2. How long will it take before my child will see results?
9. Will I have to take these medications forever?
8. Will I be able to afford this medication?
7. JAK inhibitors are still pretty new – are you sure they’re safe?
6. I read that JAK inhibitors increase the risk of blood clots. Should I be worried?
5. Can taking a JAK inhibitor cause cancer?
4. Why do I need to get certain vaccinations first?
3. Will taking a JAK inhibitor shut down my immune system?
2. If one JAK inhibitor doesn’t help me, does that mean none of them will?
1. Which JAK inhibitor is most likely to help me?
FAQs About Biologics for Atopic Dermatitis, Answered
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6. Should my infant still receive their routine childhood vaccinations (MMR, for example) while on biologic therapy for eczema?
Rare is the child who will willingly roll up their sleeve for an injection. And chances are, you aren’t looking forward to the jab, either (especially if your child is a baby). While an injection takes some getting used to, many parents are reassured by the fact that the medication is safe, seems to have few side effects, and is effective, says Vij. Another bonus: The biologic doesn’t require frequent lab monitoring and blood draws — something that also requires needles — not to mention extra appointments, which can be time consuming, says Kwatra. Your doctor will give you instructions on how to administer the injection, find the proper dosage, and store the medication.
It can vary from person to person, but in all likelihood, your child will start seeing results within a few months. In clinical trials, about 70 percent of children ages 6 to 11 saw some improvement in their skin after using dupilumab plus a topical corticosteroid after 16 weeks; about 30 percent had clear or almost clear skin. And, in the study published in The Lancet, more than half of the infants and children (up to age 5) saw improvement in their condition after 4 months of starting treatment.
While there can be some side effects from using this biologic, there aren’t many known ones at this time, says Vij. There may be an increased risk of conjunctivitis (pink eye), though, or pain or swelling around the injection site. Your child also shouldn’t use dupilumab if they are allergic to the medication or any of the ingredients in the injection. (If you’re not sure what’s in the medication, you can ask your pharmacist for a list of what it contains.)
Currently, dupilumab is covered under many private and commercial health insurance plans, says Kwatra, but you may have a copay for the medication or need to reach your deductible before your insurance kicks in. Most people who have Medicare will pay less than $100 a month for the medication, according to the manufacturer’s website, and most with Medicaid pay less than $10 a month. Even if you don’t have insurance, you may be eligible for a patient assistance program that can help you cover the costs. Although the list price for a monthly supply of the biologic is $3,203.39, not many people will pay that amount.
Because biologics work by targeting specific molecules in the body, they don’t suppress the immune system on a broad level, the way an immunosuppressant would, says Vij. “We think that people who are on a biologic — because we’re selectively interfering with their immune system, bringing it back to a more normal level — are actually probably not at higher risk for an infection,” says Vij. Plus, uncontrolled eczema isn’t harmless, says Kwatra. In fact, his research, published in February 2021 in the Journal of the American Academy of Dermatology, shows that people who have trouble sleeping — thanks, in part, to the chronic itchiness from atopic dermatitis — have increased levels of C-reactive protein, a marker of inflammation, circulating in their blood. (C-reactive protein has been linked to disorders such as hives and sleep apnea.) “I often tell parents that there is a consequence of chronic inflammation,” he says.
Biologic therapy shouldn’t affect your child’s compliance with national recommendations for routine vaccinations. Research suggests that the live-attenuated measles-mumps-rubella (MMR) vaccine is safe for young children who are being treated with biologics. “I routinely recommend patients on biologics to stay up-to-date on their routine vaccines, including the COVID-19 series,” Vij notes. “[This is] especially important for children suffering from moderate-to-severe atopic dermatitis who have altered immune function.”
