From the FDA Drug Label
The mechanism of dupilumab action has not been definitively established. Dupilumab is a human monoclonal IgG4 antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling by specifically binding to the IL-4Rα subunit shared by the IL-4 and IL-13 receptor complexes.
The effect of Dupixent (dupilumab) on immunosuppression is not directly stated in the provided drug labels. However, dupilumab's mechanism of action involves inhibiting IL-4 and IL-13 signaling, which are important components in the pathogenesis of various inflammatory diseases.
- Inhibition of IL-4 and IL-13 signaling may have implications for the immune system, but the labels do not provide clear information on whether dupilumab causes immunosuppression.
- The labels do mention that antibody responses to non-live vaccines were similar in dupilumab-treated and placebo-treated subjects, suggesting that dupilumab may not significantly impair the immune response to vaccines. However, without direct information on immunosuppression, no conclusion can be drawn about the effect of dupilumab on immunosuppression 1 1.
From the Research
Dupixent (dupilumab) is not considered an immunosuppressant medication, as it works by specifically blocking interleukin-4 and interleukin-13 signaling, which are involved in type 2 inflammation, thereby modulating rather than suppressing the immune system. This targeted mechanism means that patients on Dupixent do not generally experience increased susceptibility to infections that typically occur with immunosuppressive medications. According to a study published in 2021 2, Dupilumab treated patients were at higher risk of COVID-19, but infections were less severe, suggesting that Dupixent may even be protective in certain cases.
Key Points
- Dupixent works by specifically blocking interleukin-4 and interleukin-13 signaling, which are involved in type 2 inflammation
- This targeted mechanism means Dupixent modulates rather than suppresses the immune system
- Patients on Dupixent do not generally experience increased susceptibility to infections that typically occur with immunosuppressive medications
- Clinical trials have not shown significant increases in serious infections, opportunistic infections, or reactivation of latent infections like tuberculosis
- The medication is administered as a subcutaneous injection, with dosing typically starting at 600mg (two 300mg injections) followed by 300mg every other week for most adult indications
Implications for Treatment
The use of Dupixent has been shown to be effective in treating conditions like atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyps, while maintaining the body's ability to fight infections through other immune pathways. As noted in a study published in 2019 3, Dupilumab has been used to treat severe atopic dermatitis refractory to systemic immunosuppression, with significant improvement in disease severity and quality of life. Additionally, a study published in 2021 4 discussed the transitioning of patients from immunosuppressants to Dupilumab, highlighting the importance of strategic tapering and minimizing the risk of flare.
Recommendations
Based on the most recent and highest quality study 2, it is recommended that Dupixent be considered a viable treatment option for patients with conditions like atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyps, without the increased risk of immunosuppression. Patients should still report any signs of infection to their healthcare provider while on Dupixent, and the medication should be administered as a subcutaneous injection, with dosing typically starting at 600mg (two 300mg injections) followed by 300mg every other week for most adult indications.