Dexamethasone and Dupilumab (Dupixent) Can Be Safely Given Together
Yes, dexamethasone and dupilumab can be safely administered together, and in some cases, this combination may be beneficial for managing certain conditions, particularly dupilumab-related ocular surface disorders (DROSD). 1
Evidence Supporting Combined Use
- Dupilumab (an IL-4 receptor alpha antagonist) does not have known drug interactions with corticosteroids like dexamethasone 1
- Topical dexamethasone eye drops (0.1%) are specifically recommended for managing DROSD when patients are on dupilumab therapy 1
- Studies have shown that dupilumab can be safely combined with systemic corticosteroids, including methylprednisolone, without increased adverse events 2
- Concomitant use of topical corticosteroids with dupilumab has been extensively studied in clinical trials and is considered safe and effective 3, 4
Clinical Applications of the Combination
Management of Dupilumab-Related Ocular Surface Disorders (DROSD)
- Ocular topical corticosteroids, including dexamethasone 0.1%, are recommended for treatment of moderate-to-severe DROSD 1
- For patients with DROSD requiring longer-term treatment, ophthalmologist supervision is recommended when using corticosteroid eyedrops (like dexamethasone) for >8 weeks 1
- Monitoring should include baseline retinal nerve fiber layer optical coherence tomography when using topical ocular corticosteroids long-term 1
Other Clinical Scenarios
- In patients with atopic dermatitis treated with dupilumab who have inadequate response, adding systemic corticosteroids (including methylprednisolone) has shown benefit without safety concerns 2
- Dupilumab has been successfully combined with other monoclonal antibodies without significant adverse events, suggesting its safety in combination therapies 5, 6
Important Considerations and Monitoring
- When using topical dexamethasone eye drops with dupilumab, consider early introduction of corticosteroid-sparing agents (e.g., ciclosporin drops) to facilitate corticosteroid tapering 1
- For patients requiring long-term ocular corticosteroid therapy with dupilumab, regular ophthalmology follow-up is essential 1
- Dupilumab does not exert immunosuppressive effects and does not impair cytochrome P450 isozyme activity, reducing concerns about pharmacokinetic interactions 5
Clinical Pearls
- Conjunctivitis is a common adverse event with dupilumab (reported in 26.1% of patients in real-world data), and dexamethasone eye drops may be needed to manage this complication 1
- The combination of dupilumab with systemic corticosteroids has not shown increased adverse events in studies of patients with inadequate response to dupilumab monotherapy 2
- When using dexamethasone eye drops for DROSD, maximum twice-daily dosage of 0.1% dexamethasone is recommended 1
- Consider tapering corticosteroid dosage if lesions clear, or stopping for adverse reactions to topical corticosteroids 3
In conclusion, the combination of dexamethasone (both topical and systemic) with dupilumab is supported by clinical evidence and expert guidelines, particularly for managing dupilumab-related ocular complications and for patients with inadequate response to dupilumab monotherapy.