The Food and Drug Administration has approved a lotion containing two medications for the treatment of plaque psoriasis in adults.
This condition causes the skin to develop thick, scaly patches called plaques, often on the knees, elbows, lower back, and scalp.
Plaque psoriasis is the most common type of psoriasis according to the American Academy of Dermatology. People who develop this condition usually have it for life.
Duobrii, sold by Bausch Health Companies Inc., combines a corticosteroid (halobetasol propionate) and a topical retinoid (tazarotene).
This is not only more convenient for people with plaque psoriasis, but also provides greater results over either of the drugs alone.
“The synergistic effect of having a retinoid with a steroid cream is going to make the skin turn over faster and make the steroid cream work much better,” Dr. Michele S. Green, a dermatologist at Lenox Hill Hospital in New York City, told Healthline.
The two medications in Duobrii work together to slow the growth of skin cells and reduce the symptoms of plaque psoriasis.
This is currently the only topical lotion on the market to include both of these medications.
In a news release, the company reports that the most common side effects of the lotion included redness, itching, swelling, burning, stinging, pain at the site of application, inflamed hair follicles, thinning of the skin, peeling, and rash.
Bausch Health expects the new lotion to be available in the United States in June, according to the release.
The lotion’s wholesale cost is $825 for a 100-gram tube. Some people with commercial health insurance may be able to buy it for a $25 to $40 copay through the company’s access program.
Halobetasol propionate ointment is a super high-potency corticosteroid. Like similar drugs, long-term daily use of this medication can interfere with the body’s stress response and ability to fight infections.
As a result, the FDA recommends that people not use halobetasol propionate by itself for more than two weeks at a time.
Topical retinoids like tazarotene also have side effects that make it difficult for people to use them regularly. This includes burning, stinging, dryness, or peeling of the skin.
A small clinical trial of the safety of Duobrii found that participants could use the lotion longer without showing signs of impaired stress response or immune function.
However, Green said because the lotion contains a corticosteroid, patients still wouldn’t be able to use it forever due to safety concerns.
“But my guess is that it’s going to work faster and better,” she said, “so you won’t feel the need to use it as long.”
Dermatologists often prescribe multiple topical medications for patients with psoriasis — such as a corticosteroid with a retinoid or with a synthetic vitamin D.
This can sometimes provide benefits greater than individual treatments alone.
Dr. Samuel Hwang, PhD, a professor and chair of the Department of Dermatology at UC Davis Health, said it’s harder to get people to put on two creams instead of one.
So Duobrii’s more convenient two-in-one approach may help patients stick with their treatment. This is important because continuous treatment gives people with plaque psoriasis the best results.
However, Hwang is concerned about the cost of the new lotion, which is “significantly” higher than the medications alone.
“This agent will not replace current agents in my view,” said Hwang. “The cost is very high in relation to benefit.”
He added that most dermatologists weren’t prescribing tazarotene routinely for psoriasis.
Even those who use Duobrii may need to continue using other treatments alongside it.
As symptoms improve, people often cut back on the amount of corticosteroids they use. This reduces the risk of side effects.
Green said many of her patients use topical corticosteroids only on the weekend and another topical medication during the week.
So even with a two-in-one lotion, she said patients may still need a non-corticosteroid medication.
Hwang also thinks other newer treatments now play a bigger role in the treatment of psoriasis, including biologic medications that target the part of the immune system that is overactive.
“Biological injectable agents that are taken every 14 to 30 days have largely supplanted the need for this new topical if a patient has very resistant disease,” said Hwang.