Expert Interview
Discussing the recently approved JAK Inhibitor Opzelura Cream (Ruxolitinib)
Ticker(s): INCYInstitution: Scripps Clinic
- board certified dermatologist whose interests include medical and surgical dermatology, predominately skin cancer
- treats 10-15 patients per month with Prurigo Nodularis, 40 patients with alopecia, 200 patients with atopic dermatitis, and 100 patients with psoriasis
- published more than 20 peer-reviewed articles and book chapters
Can you discuss the current treatment algorithm for atopic derm (mild-moderate)?
Can you give a general overview of your pros and cons of Opzelura?
It's been about 6 months since the approval, can you discuss how coverage has been, with preauthorizations and everything else? The label states that it is indicated for patients who have failed topical therapies or when those therapies are not available. How restrictive has that been wrt insurers?
It's carried over the black box warning from the JAK inhibitor class. Do you think that has tampered enthusiasm or not among the dermatologist group, considering this is a topical formulation with much lower bioavailability then an oral agent?
I guess the follow-up to that is, even though the label is for patients 12 and up, do you find the black box is enough for only adults to use this drug?
The label states max BSA of 20%, do you think that is reasonable or in practice would you find that too high and would be using biologics at that point? Can you give me a sense of how much 20% BSA is?
Opzelura is intended for short term (under 8 weeks) or intermittent use. I know this will probably vary, but can you give me a sense on how long one 60g tube lasts your average patient?
Opzelura seems to be in kind of a weird spot where, to me, if it works well you don't use it again, and if it doesn't work you move on to systemic therapy. Is that aligned with actually occurs?
I'm trying to better understand, for a moderate patient, when you would use Opzelura versus a systemic therapy. Like is this going to be a go-to for patients who have failed topical therapies before you put them on a systemic therapy, or is it kind of more case-by-case, where you might put a patient who failed topicals straight on Dupixent or an oral JAKi?
I guess going a bit off-topic for a bit, for moderate-severe patients, can you discuss how the oral JAKs and have affected prescribing patterns wrt dupilumab? Given the black-box, is it safe to assume these are effectively used as second-line therapies? What are your thoughts on tralokinumab?
Are there any other products you are following in the development of atopic derm that you find interesting (ARQ-151, Tapinarof)?
On a scale of 1-10, taking into account efficacy, coverage, and everything else, how would you rate your enthusiasm for Opzelura right now?
Are there any questions on Opzelura or atopic derm that I didn't ask that you think I should have asked?
Do you want answers to these questions?
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