1. Does the injection hurt?
3. Once I start taking a biologic, will I need to take it forever?
4. Do biologics cost a lot?
5. How long will it take for me to start feeling better?
6. Will I still need to avoid foods I’m allergic to if I take a biologic?
2. How often will I have to take it?
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 Taking a Biologic for Eosinophilic Esophagitis
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Many biologics, including dupilumab, are given subcutaneously, which means they’re injected just under the surface of the skin. Because it doesn’t have to go in deep, the needle is very thin, and the sensation is often described as a “pinch.” Any discomfort is likely to occur after the injection, as it can cause tenderness and irritation at the injection site. To help prevent this, “We recommend patients change up the site from week to week,” says Dr. Cash.
If you’re prescribed dupilumab for EoE, you’ll take it once a week, at home. You won’t need to go to your doctor’s office, and you can give yourself the shot. The injector pen is designed to make it as quick and simple as possible. The medication is already in the pen, so all you have to do is swab the area with alcohol, position the needle end of the pen against your skin, and press a button at the other end.
Biologics are given subcutaneously, which means they’re injected just under the surface of the skin. Because it doesn’t have to go in deep, the needle is very thin and the sensation is often described as a “pinch.” Any discomfort from a subcutaneous injection of a biologic medication is likely to occur after the shot, as it can cause tenderness and irritation at the injection site. To help prevent this, “we recommend patients change up the site from week to week,” says Brooks Cash, MD, a gastroenterologist with UTHealth Houston and UT Physicians.
Researchers aren’t sure how long a person may need to take a biologic for eosinophilic esophagitis, says Cash. In the case of biologics prescribed for other immune disorders, some people have been able to go off the medication after some time, while others have found that if they quit taking the drug, their symptoms come back. This is likely to be true of biologics such as dupilumab when used to treat EoE. More studies are needed to understand how effective they’ll be in the long term.
As a newer medication for EoE, dupilumab can be more expensive than other therapies, says Cash. Your out-of-pocket cost for the drug will depend on whether you have health insurance and, if so, what kind of insurance it is. About 60 percent of people who have private insurance or a plan through their employer pay between $0 and $100 for a month’s worth of the drug, according to the company that makes Dupixent, the brand name for dupilumab. Others with insurance may pay more than $100 a month. About 3 in 4 people who have Medicare will pay up to $100 for a monthly supply of the drug; the other 25 percent will pay more than $100 a month. If you have Medicaid, you may pay between $4 and $9 a month. If your insurance doesn’t cover the cost of dupilumab, you may have to pay the full price for the drug — around $3,800 for a month’s worth. The manufacturer does have a patient assistance program, though, which may help you cover the cost.
Researchers aren’t sure how long a person may need to take a biologic for eosinophilic esophagitis, says Dr. Cash. In the case of biologics prescribed for other immune disorders, some people have been able to go off the medication after some time, while others have found if they quit taking the drug their symptoms come back. This is likely to be true of biologics like dupilumab when they’re used to treat EoE. More studies are needed to understand how effective they’ll be in the long-term.
In a phase 2 clinical trial of dupilumab, after 12 weeks people with EoE who took the biologic had less dysphagia (trouble swallowing) and lower levels of eosinophils than people who took a placebo. That said, you may see some improvement in symptoms after taking the drug for as little as four weeks.
If you know you’re allergic to a particular food, it’s a good idea to steer clear of it whenever possible, even if you’re taking medication, says Cash. But, he adds, if cutting back on certain foods hasn’t improved your symptoms, it may not be necessary to limit your diet.
If you’re prescribed dupilumab for EoE, you’ll take it once a week, at home. You won’t need to go to your doctor’s office and you can give yourself the shot. The injector pen is designed to make it as quick and simple as possible — the medication is already in the pen, so all you have to do is swab the area with alcohol, position the needle end of the pen against your skin, and press a button at the other end.
