What is the use of Dupixent (dupilumab) for atopic dermatitis (eczema)?

From the Guidelines

Dupixent (dupilumab) is a highly effective treatment option for moderate-to-severe eczema (atopic dermatitis), with strong recommendations for its use based on recent guidelines 1.

Key Points to Consider

• Dupixent works by blocking specific inflammatory proteins (IL-4 and IL-13), which are key contributors to the pathology of atopic dermatitis, as evidenced by increased expression of these interleukins in lesional skin compared to nonlesional or control skin 1.
• The medication is typically administered as a subcutaneous injection, with an initial dose of 600 mg (two 300 mg injections) followed by 300 mg every other week for adults, and weight-based dosing for adolescents and children.
• Dupixent is generally considered when topical treatments and other systemic medications have failed to control symptoms adequately, highlighting its role in the treatment hierarchy for moderate-to-severe atopic dermatitis 1.
• Most patients see improvement within 2-4 weeks, with significant reduction in itching, redness, and skin lesions, as demonstrated by clinical trials such as SOLO1, SOLO2, LIBERTY AD CHRONOS, and LIBERTY AD CAFÉ, which showed improvement in Investigator’s Global Assessment (IGA) or achievement of EASI 75 (≥75% reduction in Eczema Area Severity Index score) 1.
• Common side effects include injection site reactions, conjunctivitis, and cold sores, with ocular surface adverse events being particularly prevalent, affecting 6–15% of adults treated with dupilumab in clinical trials, and up to 26.1% in real-world data 1.
• Before starting Dupixent, patients should complete any recommended vaccinations, as live vaccines shouldn't be given while on treatment, underscoring the importance of careful patient management and monitoring.
• Unlike traditional immunosuppressants, Dupixent targets specific immune pathways rather than broadly suppressing the immune system, potentially offering a better safety profile for long-term use, although long-term safety data and pharmacovigilance studies are necessary to fully understand its risks and benefits 1.
• Insurance coverage varies, so patients should check with their provider about prior authorization requirements and potential copay assistance programs, highlighting the need for comprehensive patient support and access to care.

From the FDA Drug Label

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.

Dupixent is approved for the treatment of eczema (atopic dermatitis) in patients 6 months and older with moderate-to-severe disease that is not adequately controlled with topical prescription therapies. It can be used with or without topical corticosteroids 2.

From the Research

Dupixent for Eczema

• Dupixent (dupilumab) is a subcutaneously administered, fully human IgG4 monoclonal antibody directed against the IL-4 receptor α subunit, used to treat moderate-to-severe atopic dermatitis (AD) 3, 4.
• It blocks the signalling of IL-4 and IL-13, two T helper cell type 2 cytokines implicated in the immunopathology of AD, improving multiple measures of disease severity, pruritus, sleep disturbance, anxiety and depression, and quality of life compared with placebo 3.
• Dupilumab has been shown to be effective in clinical trials, with improvements in clinical outcome parameters such as SCORAD, EASI, IGA, and BSA, as well as patient-reported outcomes like DLQI or pruritus-rating-scales 4.
• The safety profile of dupilumab is considered superior to conventional immunosuppressive drugs, with common adverse reactions including conjunctivitis, injection-site reactions, and oral herpes 3, 4, 5.
• Dupilumab is generally well tolerated, with low rates of serious adverse events and treatment discontinuations due to adverse events 3.
• It is approved by the FDA for the treatment of adult patients with moderate-to-severe AD whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable 4, 6.
• Dupilumab can be used in combination with topical corticosteroids, with benefits maintained during long-term treatment for up to 1 year 3.
• Treatment options for dupilumab-associated conjunctivitis include topical corticosteroids and topical calcineurin inhibitors 5.
• Biologics, such as dupilumab, and Janus kinase inhibitors (Jakinibs) are changing the step management of moderate-to-severe AD, with guidelines recommending their use before traditional systemic anti-inflammatory agents 7.