17 December 2019

An alternative to steroid cream for atopic dermatitis

Dermatology

Pfizer’s crisaborole (Staquis) is now available in Australia on private prescription for the treatment of mild to moderate atopic dermatitis in patients two years of age and older.

The drug was registered with the TGA in February but only became available on 1 December.

It is an alternative to topical steroids and is the first topical phosphodiesterase-4 inhibitor on the market in Australia. The specific mechanism of action for crisaborole is not well-defined, but the drug is known to suppress inflammation and TNF-a secretion from the peripheral blood mononuclear cells.

It targets and blocks the phosphodiesterase-4 enzyme, which is linked to inflammation.

The TGA registration of crisaborole was based on two randomised clinical trials involving around 1,000 patients with mild-to-moderate atopic dermatitis between the ages of two years and 79. In both studies, significantly more patients receiving crisaborole treatment had a noticeable improvement in symptoms than the non-medicated group.

In addition, the evidence shows crisaborole is safe. Around 4.4% of patients experienced stinging or burning at the application site, and less than 1% of patients had hypersensitivity reactions, including contact urticaria.

Associate Professor Saxon Smith, a dermatologist from Royal North Shore Hospital in Sydney, said crisaborole had some similarity to pimecrolimus (Elidel), the other popular topical non-steroidal available for atopic eczema.

“It’s similar to … Elidel as an alternative to topical corticosteroids but it’s a very different drug to Elidel in terms of action and design and efficacy,” he said.

Pimecrolimus (Elidel) is PBS-listed for both adults and children for whom topical corticosteroids are contraindicated or don’t work.

Crisaborole, on the other hand, is not PBS listed, and the price recommended by Pfizer is $139 for a 60g tube. On average, patients tended to use 1.4 of these tubes each year, Pfizer said.

Pfizer applied for PBS listing of Staquis in November 2018 but the application was rejected. The company said it was investigating reapplying for a listing.

Crisaborole can be applied topically on most skin areas, including the head, face and neck.

However, use on the scalp has not been studied.

It is recommended the topical treatment be used twice daily for up to 28 days at a time.