There’s a new eczema pill that offers quick and lasting relief – here’s what you need to know

 

Eczema sufferers, there is now another treatment option you can look into. And it's even subsidised by the government.

The once-daily oral tablet, known as abrocitinib, targets moderate-to-severe eczema. It is suitable for candidates for systemic therapy, which uses medications that reach and affect cells all over the body. (An example of a systemic medicine is paracetamol; you might have taken it for a headache but it'll work throughout your body to reduce pain elsewhere.) The new tablet also spells hope for these patients whose eczema isn't always sufficiently controlled by topical medications. 

Eczema or its most common iteration, atopic dermatitis, is a chronic inflammatory disorder that affects 11 per cent of adults and 20 per cent of children in Singapore. Although developing eczema in adulthood is uncommon, a significant number of local patients do get it after age 21.

Sufferers often experience skin inflammation that leads to itchy patches of skin with flaking, cracking, swelling, oozing, crusting, dryness, pain and sensitivity. These symptoms occur in different stages and can come and go. While an intense moisturiser is often sufficient for mild eczema, more severe eczema requires therapy and medication.

 

“Phototherapy, conventional immunosuppressants and lately, biological therapies delivered via bi-weekly injections, are usually considered for patients with moderate-to-severe atopic dermatitis who do not respond adequately to topical treatments,” said Adjunct Associate Professor Derrick Aw Chen Wee, the education director and a senior consultant with Sengkang General Hospital’s Dermatology Service.

If you have eczema, are you a suitable candidate for this new medication? How does it work? And would you still need topical corticosteroid? Adj Assoc Prof Aw explains below.

HOW DOES ABROCITINIB WORK?

Abrocitinib is a JAK (short for Janus kinase) inhibitor, which means it suppresses certain signalling pathways within immune cells. This then reduces the release of cytokines or inflammation-causing substances that give rise to eczema, said Adj Assoc Prof Aw.

According to the US National Eczema Association’s website, the JAK family has four members and JAK inhibitors can target one or more of its members to inhibit the inflammatory effect of the cytokines involved in eczema. In abrocitinib’s case, it selectively blocks JAK1. 

 HOW EFFECTIVE IS IT?

Clinical trials of abrocitinib have shown that it can quickly improve eczema severity and itch in as early as the second week of treatment, according to National Eczema Society in the UK. In these tests, over 3,800 adults and adolescents with moderate to severe eczema were recruited to take either a daily dose of 100mg or 200mg, or a daily dose of placebo for 12 weeks.

In one trial, abrocitinib was found to be significantly more effective than the placebo at reducing the amount of body area affected by eczema, inflammation and itch – and lasted until the end of the trial. In the other trial, abrocitinib reduced itch severity compared with the placebo within 24 hours of starting treatment.

HOW IS ABROCITINIB DIFFERENT FROM A BIOLOGIC?

The difference lies in the way biologics and JAK inhibitors work on the immune system, according to National Eczema Association. Immunosuppressants such as biologics and JAK inhibitors stop certain actions of immune cells to combat eczema. But while a biologic targets the outside of these cells, a JAK inhibitor inhibits an immune-system target inside of the cells.

Also, a biologic is made from living organisms or their components such as proteins – and biologics require injections. On the other hand, abrocitinib can be taken in a 50mg, 100mg or 200mg tablet. 

HOW LONG DO I HAVE TO STAY ON ABROCITINIB? DO I STILL NEED TO USE TOPICAL CORTICOSTEROID?

“Patients usually stay on abrocitinib for many months and even years to maintain good control of their atopic dermatitis,” said Adj Assoc Prof Aw. “In some cases, eczema may still occur in a few places, and it can be easily managed with topical corticosteroid. Moisturisers should be continued indefinitely.”

WHO ISN’T SUITABLE FOR THIS NEW TABLET?

If you’ve had an allergic reaction to other JAK inhibitors before, you may be ruled out for abrocitinib. However, Adj Assoc Prof Aw said that such an allergy is rare. Other factors that could preclude you include liver failure and active serious systemic infections such as tuberculosis. Pregnant and/or breastfeeding patients are also not suitable.

“Patients at higher risk of venous thromboembolism (VTE), major adverse cardiovascular event (MACE) and malignancy should consult their doctors to assess their suitability for abrocitinib,” he added.

I AM ALREADY ON OTHER FORMS OF ECZEMA TREATMENT. CAN I START ON ABROCITINIB IMMEDIATELY?

It depends on what treatment you’re on, said Adj Assoc Prof Aw. If it’s phototherapy, it is recommended that you wait four to six weeks first. “For patients undergoing immunosuppressants, it is recommended that they wait longer, for eight to 12 weeks, before they are considered for abrocitinib.”

ANY CONTRAINDICATIONS WITH OTHER MEDICINES?

Before starting abrocitinib, make sure to inform your doctor if you’re already taking medications for:

Condition	Medication	Contraindication
Fungal infection	Fluconazole	May increase abrocitinib's side effects
Depression	Fluoxetine, fluvoxamine	May increase abrocitinib's side effects
Stroke	Ticlopidine, clopidogrel, dabigatran	May increase side effects of abrocitinib,  clopidogrel and dabigatran
Stomach acid reflux	Antacids, famotidine, omeprazole	May reduce the amount of abrocitinib in the blood
Heart failure	Digoxin	May increase digoxin's effects
Seizure	S-mephenytoin	May increase S-mephenytoin's effects

HOW MUCH MONEY CAN I SAVE?

Abrocitinib was added to the Ministry of Health’s Medication Assistance Fund (MAF) list on Mar 1, 2024, which means you may be eligible for up to 75 per cent off the medication’s cost, depending on your monthly per capita household income or PCHI. For instance, patients with a monthly PCHI of between S$2,800 and S$6,500 are eligible for a subsidy of up to 50 per cent. 

 

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.   

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