Educating Patients About Adverse Effects Can Improve Adherence

In this interview with Pharmacy Times, Matthew Zirwas, MD, discusses common misconceptions and adherence challenges surrounding topical ruxolitinib (Opzelura; Incyte Dermatology) in vitiligo and atopic dermatitis. He addresses patient fears stemming from the medication’s boxed warning, clarifying that the risks primarily pertain to systemic JAK inhibitors, not topical formulations. He further differentiates treatment approaches for vitiligo and atopic dermatitis, emphasizing the importance of consistent application for vitiligo on the face and a proactive, as-needed strategy for atopic dermatitis to maximize efficacy and patient quality of life.

Pharmacy Times: In your experience, what are the most common misconceptions or misunderstandings patients have about topical ruxolitinib that lead to nonadherence?

Matthew Zirwas, MD: So, the biggest thing that leads to challenges with Opzelura (ruxolitinib) is the boxed warning. And so Opzelura comes with a boxed warning that warns about things like immunosuppression, heart attacks, cancer, death, blood clots, and the fact is, there are no data that actually show any increased risk of any of those things with Opzelura. It is a boxed warning that was put on all JAK inhibitors as a class, whether they were topical or systemic. And so, the biggest thing that I try and do is tell patients that whenever they get that information, whenever the prescription gets filled, if they look at it, to not be terrified. And so, the way that I end up putting it to them is, ‘Well, whenever you get this from the pharmacy, you're going to get some information about some really scary-sounding things. Now, I want you to know we have a ton of data now, and that data has all shown that those scary-sounding things, there actually is no increased risk when you're using this cream, but I would recommend that you do not eat the cream.’ And then patients kind of laugh, of course. So, that's the biggest thing that I think impacts compliance, is that if patients don't realize that that warning really only applies to... JAK inhibitors taken systemically, it might make them hesitant to use it in the way that it should be used.

Pharmacy Times: What patient-related factors can significantly impact adherence, and how do you counsel about these?

Matthew Zirwas, MD: Yep. So, the key thing is we're going to talk about Opzelura in 2 different ways. First, let's talk about it for vitiligo. The key thing with vitiligo [is that] I actually think of Opzelura for vitiligo as being something that I'm pretty much only going to use on the face because the face responds most effectively, and it's also the area that people are most concerned about. So, getting people to use it twice daily on their faces is the big thing that I really try and focus on. Make sure they get it on at least once a day. You know, I tell them actually to keep it next to their toothpaste, and hopefully they can apply it a second time at night, but it's really important that they use it consistently and that they know that it's likely going to be months before they see any response.

Now, it's kind of the opposite thing with atopic dermatitis. So, Opzelura for vitiligo is the slowest drug we have for any purpose in all of dermatology. Opzelura for atopic dermatitis is the fastest drug we have for any purpose in all of dermatology. So, the best data says that Opzelura starts [working in] 2 minutes for itch, and the data that we have says that with as-needed use, 75% to 80% of patients will maintain being clear or almost clear. So, with Opzelura, the description is ‘Try and use it once or twice a day, every day, and everywhere you've got eczema until your eczema is better. Then, once your eczema is better, you can stop using it, but as soon as you notice it's starting to come back somewhere, immediately start using it again. Try not to let the eczema get ahead of you.’ Because sometimes patients say, ‘Well, maybe I'll wait to see if it doesn't get any better.’ No. As soon as they notice any eczema coming back, anywhere, they should immediately restart the Opzelura. And that sort of maximizes how quickly it's going to go back to clear, and it's going to maximize their quality of Life as well.