One of the many unsolicited messages that I receive daily on my computer screen informed me recently that Rinvoq has retaken the crown for top drug ad spender ($55.8 million in November) from Dupixent. I recall seeing unwanted TV ads for both drugs, but I had no idea that I was being visited by TV drug ad royalty. That seemed to call for a closer look at the advertisements urging patients to ask their doctors about one drug or the other.
Dupilumab (Dupixent) is a subcutaneously injected monoclonal antibody that inhibits the signaling of two inflammatory cytokines (IL-4 and IL-13). It has several FDA-approved indications, but most of the ads I remember seeing were for use in atopic dermatitis (“Hide my skin? Not me!”). The Medical Letter reviewed the drug in an article on Drugs for Atopic Dermatitis. Comparing the 60-second TV ad targeting a lay audience with our 8-page article for professionals is unfair, of course, but so is the use of actors with flawless skin in bathing suits to demonstrate the effectiveness of the drug. In any case, our article does serve as a reminder of what the TV ad is missing: a description of the many other topical and systemic drugs used to treat atopic dermatitis, a comparison of their effectiveness and adverse effects, and the whopping difference in cost. The wholesale acquisition cost for 3 months’ treatment with Dupixent is $10,200.
And what about the reestablished champion? Upadacitinib (Rinvoq) is an oral Janus kinase (JAK) inhibitor recently reviewed in The Medical Letter (September 2022) for its use in ulcerative colitis, but the drug is also approved for treatment of rheumatoid arthritis, psoriatic arthritis, atopic dermatitis (!), and ankylosing spondylitis. Quite a challenge for a 60-second TV ad (“Ask your doctor about Rinvoq!”). The advertisements do include a reading of the most serious adverse effects of the drug (serious infections, malignancies, death), which somehow seem more terrifying as we view the attractive actors on TV than they did in the labeling of the drug or the paragraphs in The Medical Letter. Information left out of the TV ad includes the existence of a second oral JAK inhibitor that is also FDA-approved for treatment of ulcerative colitis (tofacitinib [Xeljanz]) and costs half as much ($10,403.30 vs. $21,172.50 for 8 weeks’ induction).
The US is one of only two developed countries in the world (New Zealand is the other) that permits marketing of drugs directly to consumers. Clearly, it works. No pharmaceutical manufacturer would spend $50 million dollars in a month on a tactic that did not lead to larger profits. The next time your patients ask you questions about a drug they’ve seen advertised on TV, consider where you go to look up the answers. If it’s a free resource, you are getting what Pharma paid for, and your patients deserve better than that. I hope all the physicians, pharmacists, nurse practitioners, and physician assistants who read this will think about where to look for the unbiased information they should have when their patients ask them about Dupixent, Rinvoq, and all the ads to come.
More@MedLetter 
I am a retail pharmacist and have subscribed to the Medical Letter since graduating in 1984. It is the first resource that I reference when my patient’s inquire about “a new drug that they heard about on T.V.”. It is also a reference that I introduce my students to when on their retail pharmacy rotation (although most of them are unfamiliar with the publication). I know that I am always going to get the straight scoop on any drug reviewed and have tremendous respect for those who produce this product. In many cases, I have had to take on the role of “Mr. Buzzkill” when a patient has been hyped up by some T.V. ad introducing a new miracle drug. However, I feel, that our patients deserve better than some a superficial response to their inquiries, because we are in the best position to help them make therapeutic choices. Please keep up the great work!
Thanks, Mark. Appreciate the pointed reminder. Decades ago I used to copy the tables for “Medications for…” with AWP or other pricing info from TML. Did have an impact on my cost of care!
You should write about TV ads more frequently. And we as physicians should work to get them off the TV. We did it with tobacco, we can do it with drugs.
Thank You for addressing this, its been a personal pet peeve of mine for several years!
Thanks for this Mark. I retired 6 years ago and let my subscription to your excellent publication lapse. But friends and family continue to ask me for advice. I renewed today. Be well.
Randall Rowlett Fox Point, WI
Gee I wish your unbiased claim applied to outpatient early treatments for COVID-19…Hydroxychloroquine and Ivermetin …AND The dangers of Remdisavir ‘s use in Inpatient treatment of COVID-19 and now outpatient….
I agree, these ads are very worrisome. They have increased the profits of
pharmaceutical companies and really have not benefited the patients. When I see the “talk to your doctor” line in the ad, my BP goes up about
20 points!
Keep up the good work. I have been a subscriber to the Medical Letter since I was in Med School (a **long** time ago!).