From the Guidelines
Dupixent (dupilumab) is recommended for adults with moderate to severe atopic dermatitis, with a strong recommendation based on moderate certainty of evidence. The standard adult dosing is an initial 600mg subcutaneous injection (two 300mg injections), followed by 300mg every other week 1.
Key Considerations
- Dupixent is administered as a subcutaneous injection in the thigh, abdomen, or upper arm, rotating injection sites.
- Patients or caregivers can be trained to self-administer after proper instruction.
- Before prescribing, evaluate patients for helminth infections and consider tuberculosis testing.
- Monitor for conjunctivitis, keratitis, and hypersensitivity reactions.
Mechanism and Efficacy
- Dupixent works by inhibiting IL-4 and IL-13 signaling, key cytokines in type 2 inflammation that drives atopic dermatitis.
- Improvement is typically seen within 2-4 weeks, with continued benefit over time.
- No laboratory monitoring is required during treatment.
Comparison with Other Therapies
- Other therapies such as tralokinumab, upadacitinib, abrocitinib, and baricitinib are also recommended for moderate to severe atopic dermatitis, but dupilumab has a strong recommendation based on moderate certainty of evidence 1.
- Methotrexate is conditionally recommended with proper monitoring due to potential toxicity and lack of FDA approval for use in atopic dermatitis 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE 1.1 Atopic Dermatitis DUPIXENT is indicated for the treatment of adult and pediatric patients aged 6 months and older with moderate-to-severe atopic dermatitis (AD) whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. DUPIXENT can be used with or without topical corticosteroids.
Prescription of Dupixent for Dermatitis: To prescribe Dupixent for dermatitis, the patient should have moderate-to-severe atopic dermatitis (AD) that is not adequately controlled with topical prescription therapies or when those therapies are not advisable. Dupixent can be used with or without topical corticosteroids. The patient should be at least 6 months old.
- Key Points:
- Moderate-to-severe atopic dermatitis
- Not adequately controlled with topical prescription therapies
- Can be used with or without topical corticosteroids
- Patient should be at least 6 months old 2
From the Research
Prescribing Dupixent for Dermatitis
To prescribe Dupixent for dermatitis, consider the following:
- Dupixent (dupilumab) is effective in treating moderate-to-severe atopic dermatitis (AD) in adults, with significant improvements in Eczema Area and Severity Index (EASI) scores and quality of life measures 3, 4.
- The efficacy of dupilumab is not affected by the age of onset of AD, with similar improvements seen in patients with childhood-onset and adult-onset disease 4.
- Dupilumab improves skin barrier function in adults with AD, with significant reductions in transepidermal water loss (TEWL) and improvements in stratum corneum hydration 5.
- In pediatric patients (6-12 years old), the combination of dupilumab with topical tacrolimus is effective and safe for the treatment of severe AD, with significant improvements in clinical efficacy and quality of life measures 6.
Dosage and Administration
- The recommended dosage of dupilumab for adult patients with moderate-to-severe AD is 300 mg every 2 weeks, administered via subcutaneous injection 3, 4.
- In pediatric patients (6-12 years old), the dosage and administration of dupilumab have not been explicitly stated in the provided studies, but the combination with topical tacrolimus has been shown to be effective and safe 6.