Background
Dupilumab is an effective biologic therapy for moderate-to-severe atopic dermatitis (AD) with a favorable safety profile. However, ocular symptoms and head and neck dermatitis are frequently reported, particularly among Asian populations, necessitating closer initial monitoring. With the rising prevalence of AD, increasing dupilumab use, and limited specialist resources, this creates opportunities for a Pharmacist Eczema Clinic (PEC) to review patients 2 to 4 weeks after dupilumab initiation, replacing a dermatologist-led review.
Objectives
The primary objective was to compare the clinical outcomes of patients newly initiated on dupilumab who were reviewed by the PEC versus those reviewed by a dermatologist. Secondary objectives included evaluating patient satisfaction and cost savings in consultation fees.
Methods
A retrospective chart review was conducted at a single site (National Skin Centre, Singapore) for patients initiated on dupilumab between September 1, 2018, and January 4, 2023. The clinical outcomes and consultation fees of patients reviewed by the PEC were compared with those reviewed by dermatologists.
Results
A total of 72 patients were included, with 36 patients in each group. Both groups demonstrated comparable mean improvements in the Scoring Atopic Dermatitis (SCORAD) score (dermatologist, 19.54; PEC, 26.27; p = 0.43) and body surface area involvement (dermatologist, 12.9; PEC, 13.2; p = 0.67). The proportions of patients with improvement in SCORAD (dermatologist, 90.0%; PEC, 100.0%; p = 1.00) and body surface area (dermatologist, 77.8%; PEC, 76.5%; p = 1.00) were similar in both groups. The total numbers of medication therapy problems addressed (dermatologist, 10; PEC, 18; p = 0.09) and unplanned returns (dermatologist, 1; PEC, 0; p = 1.00) were comparable between the groups. Among the 23 PEC respondents, 96.5% rated overall care as very good or excellent. The PEC patients had a relative cost saving of 42.8% in consultation fees compared with those reviewed by dermatologists.
Conclusion
A PEC-led review can provide clinical outcomes comparable to those of a dermatologist-led review in the short term for patients initiated on dupilumab, with high patient satisfaction and reduced consultation fees.


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