What to Know About Dupixent (Dupilumab)

An injectable medication for eczema, severe asthma, and chronic rhinosinusitis

In This Article

Dupixent (dupilumab) was the first injectable medication approved by the U.S. Food and Drug Administration (FDA) for treating moderate to severe atopic dermatitis, also known as eczema, for those six years and older. It is injected subcutaneously in the thigh or lower abdomen every two weeks. It also can be used in combination with topical steroid therapies or on its own. In addition, Dupixent (dupilumab) can be used to treat severe asthma attacks in those 12 years and older who asthma needs to be further controlled. Adults who have chronic rhinosinusitis with nasal polyps can also use Dupixent (dupilumab) for treatment.

Uses

Dupixent (dupilumab) is a biologic medication, which means that it works on the whole body to change the way your immune system works. It is a human monoclonal antibody—i.e., a type of antibody created in a laboratory.

Once injected and absorbed into the bloodstream, it binds to a specific docking site that ultimately blocks the action of two messenger proteins (interleukin-4 and interleukin-13).

Research has revealed that dupilumab results in a reduction in the body surface area and severity of eczema patches, as well as scratching, which can be extremely debilitating for people with atopic dermatitis.

Dupilumab also has shown other benefits. In two 16-week phase three trials, the drug was found to reduce symptoms of anxiety and depression and improve quality of life.

Before Taking

Atopic Dermatitis

Atopic dermatitis can usually be managed with good skin care, removal of triggers and aggravating factors, and topical treatments like prescription steroid creams and ointments. Your doctor will try these treatments before considering Dupixent.

Dupixent is an option for such persistent moderate to severe eczema cases. It is also an alternative option for patients who cannot use certain other treatments. However, this medication is not for everyone and, at this time, it's really reserved for those who are experiencing significant symptoms and have no other options.

Asthma

Asthma can be controlled using various medicines. One of the first steps to treating asthma is to avoid triggers and find ways to manage symptoms. When additional treatment is needed based on a doctor recommendation, Dupixent can used to control inflammation in the lungs and improve lung function.

Before you start taking Dupixent for any condition, it's important to tell your doctor about all your medications, including any over-the-counter drugs, vitamins, or supplements.

Chronic Rhinosinusitis with Nasal Polyps

Rhinosinusitis is common condition that causes inflammation of the nasal passages and sinus system. Rhinosinusitis can be related to allergies, and it commonly impacts those with asthma and dental problems as well as those who smoke. Dupixent can be used shrink nasal polyps and treat the inflammation associated with Rhinosinusitis. It can be used to help those suffering from nasal polyps avoid surgery. Your doctor can help you better decide if Dupixent can be useful to treat your nasal polyps.

Precautions and Contraindications

Talk to your doctor about all of your health conditions, especially if you have eye problems, a parasitic infection, or asthma. Also, be sure to tell your doctor whether you are pregnant, breastfeeding, or scheduled to receive any vaccinations. With a complete medical history, they can determine if the drug is the right treatment for you.

Dosage

Atopic Dermatitis

According to the manufacturer, you will receive an initial "loading" dose of two injections (given at different sites). For teens less than 132 pounds (60 kilograms), the initial dose is 400 milligrams (mg) given in two-200 mg injections.

For teens who weigh more than 132 pounds, and for those over age 18 regardless of weight, the initial dose is 600 mg given in two-300 mg injections.

After the initial dose, Dupixent is injected once every other week: 200 mg in one injection for teens under 132 pounds, and 300 mg for teens over 132 pounds and those older than 18, regardless of weight.

Asthma

When treating asthma, those 12 years and older are given two injections of 200mg each, which is a first dose of 400mg. After the first injection, 200mg is taken every other week. Another option you should discuss with your doctor is a first injection of 600mg, which would be given in two 300mg injections. After the first dose, 300mg is taken every other week. Some patients who are taking oral corticosteroids or with co-morbid moderate-to-severe atopic dermatitis should start with a 600mg dose and then a 300mg dose taken every other week. 

Chronic Rhinosinusitis with Nasal Polyps

Adult patients should inject 300mg every other week to treat rhinosinusitis and nasal polyps

While these are the most commonly prescribed dosages, your physician will decide the dose most appropriate for you. Your dosage may be adjusted over time.

How to Take and Store

The medication is injected under the skin into the fatty layer beneath (subcutaneously). Your doctor or nurse can walk you or a loved one through how to confidently do this from the comfort of your home.

Dupixent should be stored in the refrigerator. If necessary, Dupixent can be left unrefrigerated for up to 14 days. Thereafter, it must be refrigerated or discarded.

While these are the basic steps to follow, you should always follow, and defer to, the specific instructions given to you by your health care provider.

  1. Remove the medication from the refrigerator (if applicable) and allow it to come to room temperature.
  2. Wash your hands and clean the injection area with an alcohol swab. Remove the needle cap from the syringe. Don't touch the needle.
  3. Pinch a fold of skin around the injection site. This can be the thigh or abdomen (more than two inches away from the belly button) for self-administration, or the upper arm if someone else is giving you the injection.
  4. Insert the needle at a 45-degree angle into the skin fold. Release the fold and slowly push the plunger on the syringe to administer the entire dose. (Dupixent is pre-measured.)
  5. Release the plunger and remove the syringe. Discard the syringe in an approved container.

Most people become very comfortable with the process after a few times.

Side Effects

You may experience skin irritation at the site of injection. Sores on or around the lips and throughout the mouth (oral herpes) have also been reported in Dupixent users.

Uncommon Eye Side Effects

Although rare, Dupixent can cause eye problems including:

It's important to contact your doctor right away if you experience vision problems, eye pain, or severe eye irritation.

Stop administering the medication and seek medical attention if you experience symptoms of an allergic reaction like hives, skin rash with or without a fever, swollen lymph nodes, joint pain, scratching, or a general ill feeling.

You may experience side effects not listed here, so be sure to contact your doctor with any problems or concerns.

Warnings and Interactions

Due to the effects on a person's immune system, it is advised that no one taking this medication receive any live vaccinations (e.g., the nasal spray flu vaccine or zoster vaccine).

Some people develop antibodies to the drug, which occurs when the body produces a protein to neutralize or inhibit the medication's biological effect. This may be suspected if a person stops responding to Dupixent and can be confirmed with a blood test.

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Article Sources
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  1. U.S. Food and Drug Administration. Full prescribing contents: Dupixent. Published March 2017.

  2. Deleanu D, Irena Nedelea I. Biological therapies for atopic dermatitis: An update. Exp Ther Med. 2019;17(2):1061–1067. doi:10.3892/etm.2018.6989

  3. Simpson EL, Bieber T, Guttman-Yassky E, et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitisN Engl J Med. 2016;375(24):2335–2348. doi:10.1056/NEJMoa1610020

  4. American Academy of Dermatology. Atopic dermatitis: Diagnosis and treatment.

  5. MedlinePlus. Dupilumab injection. Updated August 15, 2019.

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