From the Guidelines
Dupixent (dupilumab) is a highly effective treatment for moderate-to-severe atopic dermatitis, with a strong recommendation for its use based on recent guidelines 1. The medication works by blocking interleukin-4 and interleukin-13, key inflammatory proteins involved in allergic skin inflammation. The standard dose is 300mg injected subcutaneously every two weeks, with some patients receiving an initial loading dose of 600mg. Common side effects include:
- Injection site reactions (redness, swelling)
- Conjunctivitis (eye inflammation)
- Occasionally facial redness or herpes viral infections Most patients require long-term treatment as atopic dermatitis is a chronic condition, and symptoms typically return within months of discontinuation. However, some patients may achieve disease control allowing for extended intervals between doses or eventual discontinuation. Treatment duration decisions should be individualized based on response and disease severity. Before starting Dupixent, patients should be screened for parasitic infections and advised about potential eye symptoms, such as those related to dupilumab-related ocular surface disorders (DROSD) 2. Regular follow-up appointments are important to monitor treatment effectiveness and manage any side effects. Most patients see improvement within 4-8 weeks, though maximum benefit may take 16 weeks to achieve. In cases where patients experience DROSD, dose reduction may be a useful approach, with some studies suggesting that increasing dose intervals to 300 mg 3-weekly can lead to an improvement in DROSD symptoms 2. The decision to initiate Dupixent should be made using shared decision-making between patients and clinicians, taking into account the severity of AD, its impact on the patient, and the efficacy, safety, and accessibility of the available interventions 3.
From the FDA Drug Label
In these 4 trials, 1472 subjects were treated with subcutaneous injections of DUPIXENT, with or without concomitant topical corticosteroids (TCS). A total of 739 subjects were treated with DUPIXENT for at least 1 year in the development program for moderate-to-severe AD. The safety data in AD-1225 reflect exposure to DUPIXENT 200 mg QW, 300 mg QW and 300 mg Q2W in 2677 subjects, including 2254 exposed for at least 52 weeks, 1224 exposed for at least 100 weeks, 561 exposed for at least 148 weeks and 179 exposed for at least 260 weeks Table 6 summarizes the adverse reactions that occurred at a rate of at least 1% in the DUPIXENT 300 mg Q2W monotherapy groups, and in the DUPIXENT + TCS group, all at a higher rate than in their respective comparator groups during the first 16 weeks of treatment The long-term safety profile observed in this trial through 260 weeks was generally consistent with the safety profile of DUPIXENT observed in controlled studies. The efficacy results at Week 16 for AD-1539 are presented in Table 16. The efficacy results at Week 16 for Liberty-AD-HAFT are presented in Table 17
The effectiveness of dupixent for atopic dermatitis is supported by the data, with significant improvements in efficacy outcomes such as IGA 0 or 1, EASI-75, EASI-90, and reduction in itch. Adverse effects of dupixent include injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, and other herpes simplex virus infections. The duration of treatment with dupixent can be at least 1 year, with some subjects exposed for at least 260 weeks, and the long-term safety profile is generally consistent with the safety profile observed in controlled studies 4. In pediatric subjects 6 months to 5 years of age, the efficacy and safety of dupixent were evaluated, and the results showed significant improvements in efficacy outcomes, with a safety profile similar to that seen in adults and pediatric subjects 12 to 17 years of age with AD 5. Key efficacy outcomes for dupixent include:
- IGA 0 or 1
- EASI-75
- EASI-90
- Reduction in itch Key safety outcomes for dupixent include:
- Injection site reactions
- Conjunctivitis
- Blepharitis
- Oral herpes
- Keratitis
- Eye pruritus
- Other herpes simplex virus infections
From the Research
Effectiveness of Dupixent for Atopic Dermatitis
- Dupixent (dupilumab) has been shown to be effective in treating moderate-to-severe atopic dermatitis in adults, with significant improvements in disease severity, pruritus, sleep disturbance, anxiety, and depression, and quality of life compared to placebo 6, 7, 8, 9.
- In phase III trials, dupilumab as monotherapy or in combination with topical corticosteroids improved multiple measures of disease severity and quality of life compared to placebo 6, 7, 8.
- The benefits of combination therapy were maintained during long-term treatment for up to 1 year 6, 8.
Adverse Effects of Dupixent
- Common adverse reactions to dupilumab include conjunctivitis, injection-site reactions, and oral herpes 6, 7, 8, 9.
- Serious adverse events were rare, with similar rates between the dupilumab and placebo groups 7, 8.
- No significant dupilumab-induced laboratory abnormalities were noted 8.
Duration of Treatment with Dupixent
- The optimal duration of treatment with dupilumab is not established, but studies have shown that treatment for up to 1 year can be effective and safe 6, 8.
- Ongoing studies will help determine the clinical efficacy and safety profile of long-term use of dupilumab 9.
- The use of dupilumab with concomitant topical corticosteroids may allow for longer treatment durations and improved outcomes 7, 8, 9.