How does Dupixent (dupilumab) work to manage eczema and what are its common side effects?

How Dupilumab Works for Eczema and Its Common Side Effects

Dupilumab works by blocking the signaling of two key inflammatory proteins (IL-4 and IL-13) that drive eczema, effectively reducing inflammation, improving skin barrier function, and relieving symptoms. 1

Mechanism of Action

Dupilumab is a fully human IgG4 monoclonal antibody that specifically targets the immune system pathway involved in eczema (atopic dermatitis). Here's how it works:

• Blocks IL-4 and IL-13 signaling: Dupilumab binds to the alpha subunit of the IL-4 receptor (IL-4Rα), which is a component of both IL-4 and IL-13 receptors 1
• Interrupts Th2 inflammation: By blocking these receptors, dupilumab prevents the inflammatory cascade that leads to eczema symptoms 1
• Restores skin barrier function: IL-4 and IL-13 normally downregulate filaggrin (a protein essential for skin barrier integrity) in keratinocytes; by blocking these cytokines, dupilumab helps restore proper skin barrier function 1
• Reduces bacterial colonization: IL-4 normally downregulates defensins (antimicrobial peptides) and increases bacterial adhesion molecules; dupilumab helps reverse these effects, reducing Staphylococcus aureus colonization that worsens eczema 1

Clinical Effectiveness

Dupilumab has demonstrated significant efficacy in clinical trials:

• Achieves EASI-75 (75% improvement in eczema severity) in 59-64% of patients by week 16 1
• Provides substantial improvements in itch, quality of life, and sleep 1
• Works as both monotherapy or in combination with topical corticosteroids 1, 2

Explaining Dupilumab to Patients in Simple Terms

When explaining to patients, you can use this simplified explanation:

"Dupilumab works by blocking specific messengers in your immune system that trigger eczema inflammation. Think of these messengers (called IL-4 and IL-13) like alarm signals that mistakenly tell your skin to become inflamed, itchy, and damaged. Dupilumab acts like a shield that blocks these signals from reaching their targets. This reduces inflammation, helps repair your skin barrier, decreases itching, and improves your skin's ability to fight bacterial infections that can make eczema worse."

Common Side Effects

The most important side effects to discuss with patients include:

Ocular Side Effects

• Conjunctivitis: Most common adverse effect, occurring in 6-26% of patients 1, 2
• Dry eyes: Common and may precede conjunctivitis 1
• Management approach:
  • Mild cases: Preservative-free ocular lubricants and lid hygiene 2
  • Moderate-to-severe cases: Short-term topical corticosteroids 2
  • Severe cases: Urgent ophthalmology referral within 24 hours 2

Injection Site Reactions

• Erythema (redness) at injection site: Occurs in about 35% of patients 1
• Generally mild and well-tolerated 1

Other Common Side Effects

• Nasopharyngitis: Occurs in approximately 17% of patients 1
• Headache: Common but generally mild 3

Important Counseling Points

When discussing dupilumab with patients, emphasize:

• No laboratory monitoring required: Unlike many other systemic therapies for eczema, dupilumab doesn't require blood tests before or during treatment 2
• Administration: Subcutaneous injection every 2 weeks after an initial loading dose 2, 4
• Eye symptoms: Patients should report any eye redness, irritation, or vision changes promptly 1, 2
• Excellent safety profile: Dupilumab has demonstrated an excellent safety profile over more than 10 years of follow-up 1, 2
• Vaccination considerations: Live vaccines should be avoided immediately prior to and during dupilumab treatment 4

By explaining both how dupilumab works and its common side effects in clear, simple terms, you can help patients make informed decisions about this treatment option for their eczema.