Dupixent Side Effects
Dupixent (dupilumab) most commonly causes ocular surface disorders in 10-42% of patients with atopic dermatitis, with injection site reactions, upper respiratory tract infections, and facial redness being other frequent side effects. 1, 2
Most Common Side Effects
Ocular (Eye) Complications
Eye-related side effects are the most clinically significant adverse events, occurring in 10.9% of clinical trial patients and 20.6-25.1% in real-world cohorts. 1
- Conjunctivitis occurs in 6-15% of clinical trial patients and up to 26.1% in real-world studies 3
- Dry eyes affect 13% of all treated patients and 36% of those with ocular complications 3
- Keratitis (corneal inflammation) develops in 11% of all patients and 38% of those with ocular issues 3
- Blepharitis (eyelid inflammation) affects 8% of all patients and 29% of those with ocular complications 3
- Eye and eyelid inflammation including redness, swelling, and itching, sometimes with blurred vision 2
Important: These ocular side effects occur specifically in atopic dermatitis patients, NOT in patients using dupilumab for asthma, chronic rhinosinusitis, or eosinophilic esophagitis. 1
Injection Site and Systemic Effects
- Injection site reactions are the most common overall adverse event 2, 4, 5
- Upper respiratory tract infections 2
- Nasopharyngitis (common cold symptoms) 2, 5
- Headache occurs with increased frequency compared to placebo (RR 1.47) 6
Dermatologic Side Effects
- Facial rash or redness (head and neck dermatitis) occurs in 19.5% of patients 2, 7
- Cold sores in mouth or on lips (herpes virus infections) 2
- Erythema, pruritus, and peeling of skin in 10.9% of patients 7
Other Common Effects
- High eosinophil count (eosinophilia) 2
- Back pain 2
- Joint pain (arthralgia) 2
- Dizziness 2
- Muscle pain 2
- Trouble sleeping (insomnia) 2
Serious Side Effects Requiring Immediate Attention
Allergic Reactions
Stop dupilumab immediately and seek emergency care if you develop: 2
- Breathing problems or wheezing
- Fast pulse
- Swelling of face, lips, mouth, tongue, or throat
- Hives or severe skin rash
- Fainting, dizziness, or feeling lightheaded
- Nausea or vomiting
Eye Emergency ("Red Flag" Symptoms)
Seek emergency ophthalmology evaluation within 24 hours if you have eye redness PLUS any of the following: 1, 3, 8
- Loss of visual acuity (decreased vision)
- Ocular pain (more than just irritation)
- Photophobia (intolerance to light/light sensitivity)
- Visible corneal damage or opacity
Blood Vessel Inflammation
Rarely occurs in asthma patients, particularly when oral steroids are being reduced: 2
- Rash with worsening shortness of breath
- Persistent fever
- Chest pain
- Pins and needles or numbness in arms or legs
Joint Problems
Joint aches and pain can be severe enough to require hospitalization in some cases: 2
- Some patients develop trouble walking or moving due to joint symptoms
- Notify your healthcare provider immediately if joint symptoms develop
Risk Factors for Ocular Side Effects
Patients at highest risk for developing eye problems include: 1
- History of pre-existing dry eye disease with keratitis (OR 6.3,95% CI 1.3-31.6)
- Eyelid or facial eczema (OR 8.7,95% CI 1.8-40.6)
- Any prior eye disease (OR 2.97,95% CI 1.76-5.01)
- Prior use of ophthalmic medications (OR 5.16,95% CI 3.11-8.58)
Note: Baseline eczema severity does NOT reliably predict ocular complications. 1
Clinical Context and Discontinuation Rates
Despite these side effects, only 4.2% of patients discontinue dupilumab due to ocular complications, indicating most cases are manageable while continuing therapy. 3, 8
Most ocular complications are mild to moderate in severity, present within weeks to months of starting treatment, and are manageable with treatment while continuing dupilumab. 3
Dupilumab has an excellent overall safety profile with over 10 years of follow-up data. 3
Important Clinical Pearls
- Unilateral eye symptoms are very unlikely to be dupilumab-related and should prompt evaluation for other causes 3, 8
- Bilateral conjunctival involvement is typical for dupilumab-related ocular issues 8
- Patients should avoid environments with ocular irritants such as smoke, pollution, or cooling fans 3
- Dupilumab reduces the risk of skin infections (RR 0.54) and AD exacerbations (RR 0.44) compared to placebo 6