Off-Label Treatment Options in Dermatology, with Matthew Zirwas, MD

In an interview held at the Maui Derm NP+PA Fall 2024 conference in Nashville, the HCPLive editorial team spoke with Matthew Zirwas, MD, regarding his review of recent literature in the dermatology field and off-label drug options.

Zirwas, the director of the clinical trials and dermatitis center at Dermatologists of Greater Columbus, spoke about some of the most noteworthy articles from a wide array of journals published over the course of the last year. He noted that the talk also covered non-US Food and Drug Administration (FDA) approved approaches to treatment.

“The single most useful new drug is oral roflumilast,” Zirwas said. “It’s a PDE4 inhibitor and FDA-approved for COPD, but it went generic last year so now it's cheap…It’s a really potent PDE4 inhibitor that has a randomized, double blind placebo controlled trial showing really good efficacy for psoriasis.”

Zirwas highlighted that roflumilast will lead to around 50% of patients with psoriasis achieving 90% success in Psoriasis Area and Severity Index scores (PASI 90) about 70% of patients will achieve PASI 75. These statistics, Zirwas noted, are significant for a drug that is also known to be highly safe.

“I particularly find it useful for diseases that we don't have high-efficacy, FDA-approved therapies for,” Zirwas said. “So things like lichen planus, oral lichen planus, lichen planopilaris, granuloma annulare, and cutaneous connective tissue diseases.”

Zirwas also highlighted significant challenges in acne, specifically among patients for whom topicals will not work and long-term systemic antibiotics and isotretinoin are not viable options.

“We got a good study this year comparing metformin taken orally to doxycycline, and they were very equivalent in efficacy,” Zirwas explained. “It was studied in both men and women and the dosing was 500 milligrams twice a day. Metformin is an incredibly safe drug, and one of the safest drugs that there is…For the things that usually come up with it that people get concerned about that, I want to reassure them: It doesn't cause hypoglycemia, and so we don't have to worry that giving it to non-diabetics and making them get hypoglycemic.”

For additional information on tips for off-label treatments, view the full interview segment above.

The quotes contained in this summary were edited for the purposes of clarity.

Zirwas reported being a consultant and investigator for Arcutis Biotherapeutics, and has received grants from Amgen and UCB and personal fees from AbbVie, Dermavant, EPI Health, Galderma, Genentech/Novartis, Incyte, L’Oréal, Lilly, Pfizer, Regeneron, and Sanofi.