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Disclosure Notice: Insights for this article have been provided by Dr. Peter Lio, who has experience as a dermatologist treating patients with moderate-to-severe atopic dermatitis. He is a paid consultant of Pfizer.
The unrelenting itch from moderate-to-severe atopic dermatitis (AD), also known as eczema, can be debilitating. Patients may even struggle with symptoms for so long that they stop recognizing the severity. In some cases, they may resign themselves to accepting their experiences as status quo, shared Dr. Peter Lio, a practicing dermatologist at Medical Dermatology Associates of Chicago who also serves as an emeritus member of the National Eczema Association’s Scientific and Medical Advisory Council and current member of the Board of Directors.
According to Dr. Lio, “Some patients become accustomed to their disease. They’re so used to having it that when you ask them how they feel, they’ll say they’re having a good day or week but then if you ask those more structured questions about their condition, many patients will say, ’maybe I’m not doing okay.’”
If you’re living with moderate-to-severe AD, knowing the signs that your symptoms are not being adequately managed is an important part of long-term AD care.
Here are a couple of signs that it may be time to discuss your symptoms with your dermatologist:
1. Your AD feels unpredictable.
“AD is a dynamic disease and symptom severity can wax and wane,” said Dr. Lio. However, if you feel like your AD is unpredictable, it could be an indicator that your symptoms are not being appropriately managed.
A common misconception about AD is that experiencing symptom-free days minimizes the overall discomfort that patients experience. “Sometimes patients come in and they say, ‘I’m so sorry. Every time I see you, it looks better, but I’ve been really uncomfortable, and this is confusing,’ And they’re kind of apologetic because they don’t look ‘bad enough’,” said Dr. Lio. When working with patients to manage their condition, Dr. Lio evaluates not just the severity, but also the frequency of burdensome symptoms, like itch.
2. You avoid potential triggers.
Managing symptoms like intense itching, inflamed skin that looks red or discolored depending on skin tone, oozing skin, thickening of the skin, and scaly skin1, can feel like a full-time job.
Some patients go to great lengths to avoid potential triggers that may cause a flare-up. In the short-term, these choices may help manage symptoms, but they can have a long-term impact on patients’ lifestyles.2 Some common triggers for flare-ups include certain metals, weather changes such as extreme heat or cold, environmental allergens, and certain materials or chemicals in clothing or household products.3
“A lot of patients will tell me, ‘No, I’m okay,’” said Dr. Lio, “But then when I ask more pointed questions about their hobbies, they’re like, ‘Oh well, I can’t go running and I can’t do yoga because I get sweaty and then I get really itchy and I can’t go swimming, so I was never able to go to camp.’”
If your symptoms are frequent and severe, you may want to talk to your doctor about what you are experiencing. Together, you can work to create a care plan that will help manage your symptoms.
What can you do to help manage your AD?
Being honest and open with your doctor is important when developing your moderate-to-severe AD treatment plan.
The first step to managing your AD is to seek help from a certified dermatologist who will help you to find the right treatment for your needs and circumstances. When meeting with them, you should discuss your goals for care. Dr. Lio advises patients to find a dermatologist who they feel a connection with and who is willing to work with them to find the right treatment.
When evaluating treatment options, it’s important to discuss the benefits and risks.
Today, there are topical treatments (lotions, creams, or ointments), oral treatments, and injections. However, there is still no ‘one-size-fits-all’ option for patients. Any treatment you and your dermatologist decide on should feel customized to you and your goals.
One option that may be appropriate for patients with moderate-to-severe AD who are uncontrolled on previous or current treatment is FDA-approved CIBINQO® (abrocitinib). CIBINQO is a once-daily prescription pill for people 12 years and older that belongs to a treatment category known as Janus kinase (JAK) inhibitors. It can be prescribed to patients with moderate-to-severe AD who haven’t responded to previous treatments or for whom other treatments, including oral or injected medicines, haven’t worked well or are inadvisable. During clinical testing, more people saw 75% skin improvement with CIBINQO than those treated with a placebo after three months, with many people reporting itch reduction after just two weeks.
“This treatment can be beneficial for the right patient,” said Dr. Lio. CIBINQO comes with potentially serious side effects, including serious infections, increased risk of death, cancer and immune system problems, major cardiovascular events, and blood clots. Before you take CIBINQO, make sure you talk to your dermatologist about potential side effects and treatment considerations, Dr. Lio counseled. For instance, it is critical that patients taking CIBINQO undergo bloodwork before and during treatment to determine if CIBINQO is appropriate.
In addition to the potential serious side effects, the most common side effects seen in the clinical trials include common cold, nausea, headache, herpes simplex including cold sores, increased blood level of creatine phosphokinase, dizziness, urinary tract infection, tiredness, acne, vomiting, mouth and throat pain, flu, stomach flu, bacterial skin infection, high blood pressure, allergic skin rash to something you contacted, stomach pain, shingles, and low platelet count. These are not all of the possible side effects of CIBINQO.
Please refer to the important safety information below, including BOXED WARNING.
Dr. Lio advises that a treatment like CIBINQO may be an appropriate option for patients who have not found relief in trying to manage their AD symptoms with other treatments, including oral or injected medicines. If you feel your AD symptoms are not well controlled or adequately managed, reach out to a dermatologist to discuss your symptoms.
There are more treatment options available than ever before.4 With the right treatment, clearer skin and itch relief may be within reach.
IMPORTANT SAFETY INFORMATION AND INDICATION
CIBINQO may cause serious side effects, including:
Serious infections. CIBINQO can lower your immune system’s ability to fight infections. Do not start CIBINQO if you have any kind of infection unless your healthcare provider tells you it is okay. Serious infections, including tuberculosis (TB) and infections caused by bacteria, fungi, or viruses that can spread throughout the body, have occurred in people taking CIBINQO or other similar medicines. Some people have been hospitalized or died from these infections. Your risk of developing shingles may increase while taking CIBINQO.
Your healthcare provider should test you for TB before treatment with CIBINQO and monitor you closely for signs and symptoms of TB infection during treatment.
Before and after starting CIBINQO, tell your doctor right away if you have an infection, are being treated for one, or have symptoms of an infection, including:
CIBINQO can make you more likely to get infections or worsen infections you have. If you get a serious infection, your healthcare provider may stop treatment with CIBINQO until your infection is controlled.
There is an increased risk of death in people 50 years and older who have at least one heart disease (cardiovascular) risk factor and are taking a Janus kinase (JAK) inhibitor (such as CIBINQO).
Cancer and immune system problems. CIBINQO may increase your risk of certain cancers by changing the way your immune system works. Lymphoma and other cancers, including skin cancers, can happen. People, especially current or past smokers, have a higher risk of certain cancers, including lymphoma and lung cancers, while taking a JAK inhibitor. Follow your healthcare provider’s advice about having your skin checked for skin cancer during treatment. Limit the amount of time you spend in sunlight and avoid using tanning beds or sunlamps. When in the sun, wear protective clothing and use SPF 30+ sunscreen. This is especially important if you have very fair skin or a family history of skin cancer. Tell your healthcare provider if you have ever had any type of cancer.
There is an increased risk of major cardiovascular (CV) events such as heart attack, stroke or death in people 50 years and older who have at least one heart disease (CV) risk factor and are taking a JAK inhibitor, especially for current or past smokers.
Some people taking CIBINQO have had major cardiovascular events.
Get emergency help right away if you develop any symptoms of a heart attack or stroke while taking CIBINQO, including:
Blood clots. Blood clots in the veins of your legs (deep vein thrombosis, DVT) or lungs (pulmonary embolism, PE) can happen in some people taking CIBINQO. This may be life-threatening. Blood clots in the veins of the legs and lungs have happened more often in people 50 years and older, with at least one heart disease (CV) risk factor, taking a JAK inhibitor. Tell your healthcare provider if you have had blood clots in the veins of your legs or lungs in the past.
Stop taking CIBINQO and get medical help right away if you have any signs and symptoms of blood clots including swelling, pain, or tenderness in one or both legs; sudden, unexplained chest or upper back pain; shortness of breath or difficulty breathing.
Changes in certain laboratory test results. Your doctor should do blood tests before and during treatment with CIBINQO to check your lymphocyte, neutrophil, red blood cell, and platelet counts. You should not take CIBINQO if these counts are too low. Your healthcare provider may stop treatment for a period of time if there are changes in these blood test results.
Increased cholesterol levels. You may also have increases in the amount of fat found in your blood. Your doctor should check your cholesterol about 4 weeks after you start CIBINQO and then as needed.
During the first 3 months of treatment with CIBINQO, do not take medicines that prevent blood clots except low-dose aspirin (≤81 mg daily), if prescribed.
Before taking CIBINQO, tell your healthcare provider if you:
The most common side effects of CIBINQO include common cold, nausea, headache, herpes simplex including cold sores, increased blood level of creatine phosphokinase, dizziness, urinary tract infection, tiredness, acne, vomiting, mouth and throat pain, flu, stomach flu, bacterial skin infection, high blood pressure, allergic skin rash to something you contacted, stomach pain, shingles, and low platelet count.
Separation or tear to the lining of the back part of the eye (retinal detachment) has happened in people treated with CIBINQO. Call your healthcare provider right away if you have any sudden changes in your vision.
CIBINQO may cause fertility problems in females, which may affect the ability of females to get pregnant. Talk to your healthcare provider if you have concerns about fertility.
These are not all of the possible side effects of CIBINQO.
What is CIBINQO (si-BINK-oh)?
CIBINQO (abrocitinib) is a prescription medicine to treat adults and children 12 years of age and older with moderate-to-severe eczema (atopic dermatitis) that did not respond to other treatment and is not well controlled with prescription medicines, including biologics, or when they cannot be tolerated.
It is not known if CIBINQO is safe and effective in children under 12 years of age.
You are encouraged to report adverse events related to Pfizer products by calling 1-800-438-1985 (U.S. only). If you prefer, you may contact the U.S. Food and Drug Administration (FDA) directly. Visit www.fda.gov/MedWatch or call 1-800-FDA-1088.
CIBINQO (abrocitinib) is available in 50 mg, 100 mg, and 200 mg pills.
To learn more about moderate-to-severe atopic dermatitis and CIBINQO, visit cibinqo.com.
PP-CIB-USA-1110
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