What is Dupexin used for?

Dupilumab (Dupixent): Uses and Applications

Dupilumab (Dupixent) is primarily used for the treatment of moderate-to-severe atopic dermatitis in adults and children who have not achieved adequate control with topical medications. 1

Primary Indications

Atopic Dermatitis

• FDA-approved for moderate-to-severe atopic dermatitis in adults and adolescents
• Approved for severe atopic dermatitis in children aged 6-11 years 2
• Administered as subcutaneous injections with an initial loading dose followed by maintenance dosing:
  • Adults: 600 mg loading dose, then 300 mg every 2 weeks 1
  • Pediatric dosing varies by age and weight

Secondary Indications

• Moderate-to-severe uncontrolled asthma (as add-on maintenance therapy) 3
• Dyshidrotic eczema (off-label use with promising results) 4

Mechanism of Action

Dupilumab is a fully human monoclonal antibody that:

• Blocks both interleukin-4 and interleukin-13 signaling by targeting the IL-4 receptor α
• Inhibits key inflammatory pathways involved in type 2 inflammation

Efficacy

• Long-term studies show sustained efficacy for up to 5 years in adults with atopic dermatitis 5
• At week 260 of long-term treatment:
  • 67.5% of patients achieved clear or almost clear skin (IGA score 0-1)
  • 88.9% achieved at least 75% improvement in EASI scores 5

Safety Profile and Side Effects

Common Side Effects

• Conjunctivitis (15.6% in real-world studies) 2
• Head and neck dermatitis (19.5%) 2
• Nasopharyngitis
• Upper respiratory tract infections
• Injection site reactions

Ocular Side Effects Management

The British Association of Dermatologists provides specific guidance for managing dupilumab-related ocular surface disorders (DROSD):

1. Pre-treatment Assessment:

   • Offer prophylactic preservative-free ocular lubricants to patients with current or pre-existing corneal or conjunctival eye disease 1
   • Refer patients with significant current or chronic eye disease to ophthalmology before starting treatment 1
   • Delay dupilumab therapy for patients with corneal transplant until ophthalmology consultation 1

2. During Treatment Monitoring:

   • Classify DROSD severity as mild, moderate, or severe based on redness and symptoms 1
   • Urgently refer to ophthalmology (within 24 hours) patients with DROSD presenting with the RAPID signs:
     • Redness plus any of: Acuity loss, Pain, Intolerance to light, or Damaged cornea 1

Long-term Safety

• Exposure-adjusted rates of treatment-emergent adverse events generally remain stable or decline over time 5
• Most side effects are mild and do not require discontinuation of therapy 2
• No significant safety signals have emerged in 5-year extension studies 5

Clinical Considerations

• No laboratory monitoring is required before initiation or during treatment 1
• Conjunctivitis is a common adverse event but is typically self-limited and can be managed with artificial tears 1
• Ophthalmology referral should be considered for severe, persistent, or refractory conjunctivitis 1
• Risk factors for developing ocular complications include:
  • Previous ophthalmology attendance for ocular surface disorders
  • Higher baseline disease severity
  • Eyelid or facial eczema 1

Dupilumab represents a significant advancement in the treatment of moderate-to-severe atopic dermatitis with a favorable long-term safety profile, making it an important option for patients who have failed conventional topical therapies.