Should a 17-year-old patient on Dupixent (dupilumab) for eczema undergo regular lab work?

Laboratory Monitoring for 17-Year-Old Patients on Dupixent for Eczema

No routine laboratory monitoring is required for adolescents on dupilumab (Dupixent) for atopic dermatitis. 1

Rationale for No Laboratory Monitoring

Dupilumab is a targeted biologic therapy that has demonstrated a favorable safety profile without significant laboratory abnormalities requiring monitoring. The American Academy of Dermatology explicitly states that no laboratory monitoring is required before initiation or during treatment with dupilumab 1.

This recommendation is supported by comprehensive safety data:

• A study analyzing laboratory safety data from three phase III trials (LIBERTY AD SOLO 1, LIBERTY AD SOLO 2, LIBERTY AD CHRONOS) found no clinically important changes in test results that could be linked to dupilumab 2.

• Real-world experience in a tertiary center showed that while laboratory tests were performed (average of three sets during 255 days of treatment), 93% of abnormalities were classified as "mild" and none were attributed to dupilumab or led to treatment discontinuation 3.

Focus on Clinical Monitoring Instead

Rather than laboratory monitoring, clinical monitoring should focus on:

1. Ocular Complications

• Conjunctivitis is the most common adverse effect, occurring in approximately 5-16% of patients 3, 4

• Monitor for the RAPID signs that require urgent ophthalmology referral 1:

  • Redness plus any of:
  • Acuity loss
  • Pain
  • Intolerance to light
  • Damaged cornea

• For adolescents aged 7-17 years with dupilumab-related ocular surface disorders (DROSD):

  • Mild to moderate cases: Offer preservative-free ocular lubricants as first-line treatment 5
  • Cases not responding to lubricants: Refer to ophthalmology through standard referral pathway 5
  • Severe cases: Urgent ophthalmology referral within 24 hours or 4 weeks based on clinical judgment 5

2. Other Side Effects

• Joint pain (reported in about 2.2% of pediatric patients) 4
• Injection site reactions (monitor and manage symptomatically)

Clinical Efficacy Assessment

Instead of laboratory tests, focus on clinical assessment tools to monitor treatment response:

• Eczema Area and Severity Index (EASI)
• Investigator's Global Assessment (IGA)
• Body Surface Area (BSA) affected
• Quality of life measures

Real-world data shows that adolescents typically show significant improvement by weeks 12-24, with continued improvement beyond this timeframe 4.

Common Pitfalls to Avoid

1. Unnecessary laboratory testing: Performing routine blood tests wastes resources and may cause patient anxiety without clinical benefit.

2. Missing ocular complications: Failure to recognize and appropriately manage eye symptoms can lead to more serious complications.

3. Discontinuing effective therapy: Don't stop dupilumab due to minor laboratory abnormalities that are not clinically significant or related to the medication.

4. Delayed referral for severe ocular symptoms: Severe eye symptoms require prompt ophthalmology evaluation.

In summary, while laboratory monitoring is standard practice for many systemic medications used in dermatology, dupilumab's targeted mechanism of action and established safety profile make routine laboratory testing unnecessary for your 17-year-old patient with eczema.