From the Research
If a patient is allergic to Dupixent (dupilumab), they should not automatically be excluded from trying Ebglyss (lebrikizumab), but caution is warranted. Both medications are monoclonal antibodies that target the IL-4/IL-13 pathway for treating atopic dermatitis and other inflammatory conditions, but they have different structures. While cross-reactivity between these biologics is possible, it's not guaranteed. A patient with a true allergy to Dupixent may potentially tolerate Ebglyss, as lebrikizumab specifically targets IL-13 only, whereas dupilumab blocks both IL-4 and IL-13 signaling. Before starting Ebglyss in a patient with a Dupixent allergy, the healthcare provider should carefully evaluate the nature and severity of the previous allergic reaction, consider consultation with an allergist, and implement close monitoring if the decision is made to try Ebglyss. The first dose might be administered in a controlled setting where any potential allergic reactions can be promptly addressed. The benefits of treatment must be weighed against the risk of another allergic reaction, taking into account the patient's specific condition and treatment alternatives.
Key Considerations
- The mechanism of action of dupilumab, as described in the study by 1, involves targeting the IL-4 receptor alpha chain, which is common to both IL-4 and IL-13 signaling pathways.
- Lebrikizumab, on the other hand, specifically targets IL-13, which may reduce the risk of cross-reactivity in patients allergic to dupilumab.
- A study published in 2025, 2, demonstrated the effectiveness of dupilumab in patients with severe allergic asthma, but did not directly address the issue of cross-reactivity with other biologics like lebrikizumab.
- Another study from 2021, 3, showed that dupilumab suppresses type 2 inflammatory biomarkers across multiple atopic and allergic diseases, highlighting its potential benefits in patients with these conditions.
- However, the decision to use Ebglyss in a patient with a Dupixent allergy should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history, as suggested by the study 4.
Monitoring and Precautions
- Close monitoring is essential when initiating Ebglyss in a patient with a known allergy to Dupixent.
- The first dose should be administered in a controlled setting, such as a hospital or clinic, where any potential allergic reactions can be promptly addressed.
- The healthcare provider should be prepared to manage any adverse reactions that may occur, including anaphylaxis, and have emergency procedures in place.
- Regular follow-up appointments should be scheduled to assess the patient's response to treatment and monitor for any signs of allergic reactions or other adverse effects.