What is the recommended dosing regimen for dupilumab (Dupixent)?

Dupilumab Dosing Regimen

The recommended dosing regimen for dupilumab (Dupixent) in adults with atopic dermatitis is an initial loading dose of 600 mg (two 300 mg injections) followed by 300 mg every 2 weeks administered subcutaneously. 1

Adult Dosing for Different Indications

Dupilumab dosing varies by indication:

• Atopic Dermatitis (Adults): 600 mg loading dose, then 300 mg every 2 weeks 2, 1
• Prurigo Nodularis: 600 mg loading dose, then 300 mg every 2 weeks 1, 3
• Chronic Rhinosinusitis with Nasal Polyps: 300 mg every 2 weeks 1
• Eosinophilic Esophagitis (≥40 kg): 300 mg every week 1
• Chronic Spontaneous Urticaria: 600 mg loading dose, then 300 mg every 2 weeks 1
• Chronic Obstructive Pulmonary Disease: 300 mg every 2 weeks 1
• Bullous Pemphigoid: 600 mg loading dose, then 300 mg every 2 weeks 1

Pediatric Dosing for Atopic Dermatitis

Weight-based dosing for children:

• 15 to <30 kg: 600 mg loading dose, then 300 mg every 4 weeks 1
• 30 to <60 kg: 400 mg loading dose, then 200 mg every 2 weeks 1
• ≥60 kg: 600 mg loading dose, then 300 mg every 2 weeks (same as adults) 1
• 5 to <15 kg: 200 mg every 4 weeks (no loading dose) 1

Administration and Monitoring

• Administer by subcutaneous injection in the thigh, abdomen, or upper arm
• No laboratory monitoring is required before or during treatment 2, 4
• Monitor for ocular complications, particularly conjunctivitis, which occurs in 5-16% of patients 4

Efficacy and Maintenance

Clinical trials demonstrate that the standard dosing regimen (300 mg every 2 weeks) maintains optimal efficacy for long-term treatment:

• The LIBERTY AD SOLO-CONTINUE trial showed that maintaining the standard dosing regimen provided the most consistent response over time 5
• Longer dosing intervals (every 4 or 8 weeks) resulted in diminished efficacy 5
• All members of the American Academy of Dermatology guideline workgroup favored dupilumab as first-line systemic therapy for atopic dermatitis 2

Managing Adverse Effects

Ocular Complications

• Conjunctivitis is the most common adverse effect (5-16% of patients) 4
• Management approach:
  1. Mild cases: Preservative-free ocular lubricants and lid hygiene 2, 4
  2. Moderate-to-severe: Consider short-term treatment with topical corticosteroids (typically preservative-free dexamethasone 0.1%) for up to 8 weeks 2
  3. Severe cases: Urgent ophthalmology referral within 24 hours 4

Dose Adjustment for Ocular Side Effects

• In patients with dupilumab-related ocular surface disorders (DROSD), increasing the dosing interval to 300 mg every 3 weeks led to improvement in 47% of cases while maintaining disease control 2
• Consider this approach in patients with good skin control but troublesome ocular side effects

Clinical Pearls and Pitfalls

• Avoid unnecessary laboratory testing as it wastes resources and may cause patient anxiety without clinical benefit 4
• Don't miss ocular complications - refer to ophthalmology promptly for severe symptoms 4
• Maintain optimal dosing - extending intervals beyond 2 weeks significantly reduces efficacy 5
• Treatment-resistant disease may require consideration of alternative therapies such as JAK inhibitors 2
• Antidrug antibody development is less common with more frequent dosing regimens 5

Special Populations

• Patients with renal disease: No dose adjustment needed
• Patients with hepatic impairment: No specific recommendations; use with caution
• Pregnancy: Limited data available; use only if potential benefit justifies risk

Dupilumab has demonstrated an excellent safety profile in clinical trials and over 5 years of clinical practice, making it the preferred first-line systemic agent for atopic dermatitis according to expert consensus 2.