Neal Patel was in the middle of writing his medical board exams when suddenly, his skin began to itch. This wasn’t a normal itch. It was the feeling that he had grown up with, the one he had prayed would not happen that day. He could feel his body getting warm and though he kept his hands firmly on his test papers, his mind was overwhelmed by the need to scratch.
“It was almost this feeling of impending doom. You feel it. You feel this heat coming on and you feel that your body is about to flip,” he explained. “I spent so much energy trying to force myself not to itch that I wasn’t able to read.” Finally, he had to get up and take an hour-long break from the exam to scratch his entire body and apply lotion.
The 26-year-old New Jersey Medical student is one of nearly 18 million Americans who suffers from moderate to severe eczema. Patel has endured flare-ups of painful, dry, broken skin all over his body since birth. As an adult, his condition caused cuts that bloodied his sheets, required him to wear silk garments under his clothes, and made simple tasks like exercise or showering a burden. But for the first time, thanks to a novel drug, Patel is finding relief from the extreme itch of eczema.
The drug, dupilumab, is a weekly injection that blocks two signaling proteins which are key to the immune response that leads to the cracked, dry and inflamed skin of eczema, or atopic dermatitis. Essentially, unlike other treatments, this drug treats the root cause of the disease rather than its symptoms. Results from the study, published in the Journal of Allergy and Clinical Immunology, are so promising that the FDA has designated the drug a “breakthrough therapy” to fast-track its development for moderate to severe eczema.
“With this treatment, we managed to show that when you target specific molecules in the skin, you basically improve the skin barrier, proving that it’s primarily an immune abnormality that we need to go after,” lead author Dr. Emma Guttman-Yassky, told Allergic Living.
When Patel first met with the New York researcher, his skin was peeling and weeping. His symptoms were so severe that he agreed to take a year off to participate in her clinical trial for the experimental drug.
Prior to dupilumab, eczema like Patel’s was usually treated with corticosteroids or cyclosporine immunosuppressant pills. But both carry the risk of side effects such as kidney and blood pressure problems and once the dosage is complete, symptoms often return, as Patel says, “with a vengeance.”
After the first injection of the new drug, Patel noticed he was itching less. After the second dose, his skin began to clear up, allowing him to return to routine tasks like exercise and daily showers, without worrying about drying out or irritating his eczema – results that Guttman-Yassky says are fairly typical.
According to the dermatologist’s research, in one month, patients who received weekly 300 mg injections of dupilumab showed greater disease control than those who are on cyclosporine pills for three months.
“It was like my skin became stronger, more durable, more tough. Everything really changed,” Patel sad in an interview. “It was so dramatic it was unbelievable.”
Guttman-Yassky, a dermatologist at the Icahn School of Medicine at Mount Sinai, says that by targeting specific molecules related to the disease, rather than the immune system at large, side effects are reduced and the effectiveness is increased. So far, no major side effects have been seen with dupilumab.
This is also the first study to ever confirm that eczema is, in fact, an autoimmune disorder. According to Guttman-Yassky, who was motivated to study this condition because both she and her daughter have eczema, this novel type of targeted therapy is not limited to eczema treatment – in fact, her results have already prompted research into multiple new therapies for asthma, psoriasis and other disorders.
“Dr. Guttman-Yassky is really changing the world,” said Dr. Mark Lebwohl, chair of Mount Sinai’s dermatology department. “She is opening the door to new therapeutic discoveries and helping to improve the quality of lives of patients.”
With his eczema at bay, Patel, who now self-administers the weekly injections at home, approaches his professional, dating, and social life with confidence and comfort. He hasn’t had a flare-up since starting the drug.
“I still have [eczema] but it’s way more manageable,” he says. “My life has changed in that I’ve regained normalcy now.”
Dupilumab is still being tested, but Guttman-Yassky hopes the drug could be available as soon as 2017.