What are the potential causes of worsening eczema and asthma exacerbation after initiating Dupixent (dupilumab) therapy for eczema, asthma, and sinusitis?

From the Guidelines

You should continue your Dupixent injections as prescribed, typically 300mg every two weeks after the loading dose, and give the medication at least 12-16 weeks to reach its full effectiveness. During this adjustment period, maintain your regular asthma controller medications and use rescue inhalers as needed for breakthrough asthma symptoms, as recommended by the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma 1. For temporary eczema flares, continue your topical treatments such as moisturizers and prescribed corticosteroid creams. These fluctuations occur because Dupixent works by blocking interleukin-4 and interleukin-13 signaling, which gradually modifies your immune response, as explained in the study on dupilumab-related ocular surface disorders in people with atopic dermatitis 1. The body needs time to adjust to these changes, and it's not unusual to see varying responses in different conditions (eczema, asthma, sinusitis) during the initial weeks.

Some key points to consider:

• The effectiveness of dupilumab in treating moderate-to-severe atopic dermatitis has been demonstrated in clinical trials, with significant improvements in eczema area severity index (EASI) scores and quality of life 1.
• The safety profile of dupilumab has been shown to be excellent, with the most prevalent adverse effects being ocular surface disorders, which can be managed with topical corticosteroids and other treatments 1.
• It's essential to work closely with your healthcare provider to monitor your symptoms and adjust your treatment plan as needed, considering the potential risks and benefits of dupilumab and other therapies, such as Janus kinase inhibitors, which have been licensed for the treatment of atopic dermatitis 1.
• If symptoms become severe or concerning, contact your healthcare provider, as they may recommend temporary supportive treatments while your body adjusts to Dupixent.

From the Research

Eczema, Asthma, and Sinusitis Response to Dupixent

• The user has been taking Dupixent for 2 weeks and has noticed improvements in asthma during the first week, but eczema worsened with increased itchiness 2, 3.
• In the second week, eczema has calmed down slightly, but asthma symptoms have returned 2, 3.
• Studies have shown that Dupilumab, the active ingredient in Dupixent, can improve eczema symptoms, including itchiness, and also has a positive effect on asthma and sinusitis 4, 5, 6.

Dupixent's Effect on Eczema

• Dupilumab has been shown to improve multiple measures of disease severity, pruritus, sleep disturbance, anxiety, and depression, and quality of life in patients with moderate-to-severe atopic dermatitis 2, 3.
• A long-term study found that patient-reported benefits of dupilumab were maintained during treatment up to 36 months, with significant reductions in concomitant AD therapy use and improvements in disease control and treatment satisfaction 4.

Dupixent's Effect on Asthma and Sinusitis

• Dupilumab has been found to improve asthma control and sinonasal outcomes in adults with moderate to severe atopic dermatitis, with significant improvements in Asthma Control Questionnaire-5 (ACQ-5) scores and Sino-Nasal Outcome Test-22 (SNOT-22) scores 6.
• The improvement in asthma and sinusitis symptoms was seen in patients with both conditions, as well as in those with only one of the conditions 6.

Variability in Response to Dupixent

• The user's experience of initial improvement in asthma followed by a return of symptoms is not uncommon, as individual responses to dupilumab can vary 2, 3.
• Factors such as concomitant use of other medications, disease severity, and individual patient characteristics may influence the response to dupilumab 2, 3, 4, 5, 6.