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At the recent American Academy of Dermatology annual conference, Elizabeth Jones, MD, FAAD, Thomas Jefferson University Hospitals, spoke on scenarios where less expensive, older generic therapies can play a role in treating dermatologic disease.
She emphasized factors such as cost-effectiveness, insurance mandates, the need for rapid symptom relief in acute cases, patient preferences regarding administration routes and immunosuppression, and the lack of conclusive evidence favoring newer options in certain rare diseases. Essentially, while newer drugs offer targeted action, older generics remain valuable due to practical considerations and established efficacy in specific scenarios.
This transcript was lightly edited for clarity; captions were auto-generated.
Transcript
With the emergence of newer, often more expensive, targeted therapies, how do you determine when an older generic medication remains the most appropriate first-line treatment, particularly considering cost-effectiveness and patient adherence?
As dermatologists, we do come into these situations, especially with inflammatory skin disease, where, in the grand scheme of medicine, the diagnosis that we’re currently treating is overall pretty rare. We don’t have a lot of medications that have been vetted, and we have a couple [of] select medications that, historically, we have used that work very well. A really good example of that is our use of dapsone to treat dermatitis or piriformis, but there are many reasons why we would have to consider an older, generic medicine as the best.
One being, again, cost is the big issue. Some of those newer medicines are nice and targeted, but they’re very expensive, not realistic in a patient’s budget, even the copays can be very high. Sometimes you are tied to that insurance mandate, as well. There’s different step therapies, and sometimes we do end up having to go with something that an insurance may cover that’s better for the patient.
With a lot of the medications, sometimes we don’t have the time to wait for the approval; we don’t have the time to wait for a ramp-up period for some of the newer medicines. Often, for example, a biologic may require about 3 months to take full effect, but we have a patient in front of us who is very acute and needs something quicker acting.
In psoriasis, for example, a patient in the hospital suffering from a widespread pustular rash, we don’t have time to wait and we often use cyclosporine to bridge the patient until they can get a different medication. That’s another great use.
Patient choice, a lot [of times] will also dictate that. If they have a fear of needles, if they only want an oral medication, if they want to avoid a medication that’s more immune suppressing, then some of these older, generic medications are easier for them to take. It may not be as suppressive to their immune system. For example, dapsone or colchicine, so there’s a lot of great examples that we run into.
The final thing being that we don’t have a lot of evidence that otherwise suggests that something is more effective. We have to be very keen on what’s out there and what we can use for our patients in these select cases where the disease is rare.
