In this Contemporary Pediatrics interview, Bernard A. Cohen, MD, discusses VP-102, approved by the FDA on July 22, 2023, to treat molluscum contagiosum in pediatric patients 2 years and up.
Watch as Bernard A. Cohen, MD, professor of pediatrics and dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, explains how VP-102 (YCANTH; Verrica Pharmaceuticals) will be used to treat molluscum contagiosum in the pediatric population. The treatment was approved by the FDA on July 22, 2023. Click here for more on the approval and various phase 3 trials.
Transcript (edited for clarity):
What is your initial reaction to the July 22, 2023, FDA approval of VP-102 (YCANTH; Verrica Pharmaceuticals) to treat molluscum contagiosum in children 2 years and up?
Bernard A. Cohen, MD:
My reaction to the approval by the FDA was really relaxed and comfortable and I was just kind of excited that it was approved, because there are a ton of different things that are used out there and many of which are quite innocent. Some of which I do think work, although they haven't been studied carefully, although there are a couple of newer products that are being looked at as well. But it's kind of nice to have something that's approved, that looks to have a relatively low risk of severe irritation or side effects and then it looks like it works reasonably well. We did a study which I just went back to take a look at, published in 2015, we had over 700 Kids in the study, we looked at a survey kids, at that point that went back another 4 or 5 years from our center, and we actually follow these patients for 12 to 18 months. What was interesting is that at 12 months, 50% of the kids, many of whom are not treated, actually had a resolution. So, I'm not saying that we shouldn't treat it and there certainly are children, where it is a psychosocial disaster or if they have a large number, which thank God doesn't happen that often, can be quite irritating or become secondarily infected and cause significant side effects from no treatment. It's cool to have something that looks to be relatively safe, relatively low irritating risk, and that is approved now by the FDA, based upon the phase 3 trial where it show to be effective, but again, keep in mind that if a kid has a small number of lesions, and they're not visible, and it's not probably in symptoms, I'm not sure that we need to have a kid come into the doctor's office because again, they're spontaneous remission rate in healthy children, is quite high. It's just [something] to keep in mind.
What signs can general pediatricians look for when contemplating referral for molluscum contagiosum?
If you have a patient who is otherwise healthy, has a normal, intact immune system, who is not symptomatic, and is not bothered by the lesions they're not causing the psychosocial disaster, they're not infected, recognizing based upon our study, which I think is a little bit biased in the sense that we had kids who were more likely to come to dermatologist, who may have had more difficult lesions to deal with. Still, at 12 months, we had half of these kids have their lesions disappear without treatment, and it was 70% by 18 months. That may seem like a long time but again, if you have a small number of lesions are not symptomatic, I don't think there's a lot of pressure in an otherwise healthy kid or adult for that matter to treat them. Now, if you have a kid who's symptomatic, who has a large number of lesions, and may be otherwise healthy and well, but is symptomatic, or it's just like a social disaster, it's been going on for a while, and they're not early signs that it's beginning to regress, I think those are the kinds of kids that the primary care physician should talk to the dermatologist, hopefully a pediatric dermatologist, about treatment options. Again, if they're doing well, and they're not symptomatic, I think you can sit tight and watch and just recognizing that spontaneous remission maybe even in the phase 3 trials with some of these medications, one of which is approved now and others that are being looked at, that if you extend it out a little while, many of the children who are not treated it actually eventually do well. So again, just to put it in that context. The other thing is that people have been using cantharidin for 30 or 40 years and if they're not using a formulation that's well controlled, that may be higher concentration, maybe using larger areas maybe using an applicator that puts it on a larger area, he risk of getting irritating blisters from the treatment is significant and the YCANTH, agent that we're looking at here, the VP-102, comes with an applicator that's very small and the application is a 0.7% cantharidin and it's applied to a very small, restricted area with each application. So, I think you If you're going to use something like that, it makes sense to use this agent.
Can you explain how VP-102 is administered?
The way the application is done is that again, there's a special applicator that only applies a very small amount of liquid to each individual lesion. So, it restricts the blisters to a small area, I think that's very important because otherwise, I've seen some kids have some really traumatic experiences with other cantharidin products. So, I think that if you're going to treat it, something like this, and some of the other products being looked at down the road, would be things that would be appropriate to look for from a safety reason and appropriate application that's done properly. One of the things I always tell the pediatricians is that if the patient comes to your office, and some of molluscum lesions that they see that parents are concerned about have a red, irritated patch around them, that's actually something we call the beginning of the end sign. That means that the kid has begun to develop an immunologic reaction and there's a good chance that within a couple of weeks, the molluscum lesions are going to disappear. Again, just to keep in mind that it requires a visit to the dermatology office, and it's usually administered at 12-week intervals, up to I think 4 treatments total. Again, at that point, there's still a pretty good chance that within that 50% or even maybe a little bit more will respond to treatment. But again, keeping in mind that if you go up to the extended period of time without treatment that many of these will go away on their own. It's just that if the kids are symptomatic, or psychosocial disaster, I think that treatment is appropriate.