What is the recommended dose of dupilumab (Dupixent) for adults and children with atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyposis?

Dupilumab Dosing Recommendations

Atopic Dermatitis

For adults with moderate-to-severe atopic dermatitis, administer dupilumab 600 mg initially (two 300 mg injections), followed by 300 mg every 2 weeks. 1

Pediatric Dosing for Atopic Dermatitis

Ages 6 months to 5 years: 1

• 5 to <15 kg: 200 mg every 4 weeks (no loading dose)
• 15 to <30 kg: 300 mg every 4 weeks (no loading dose)

Ages 6 years and older: 1

• 15 to <30 kg: 600 mg loading dose (two 300 mg injections), then 300 mg every 4 weeks
• 30 to <60 kg: 400 mg loading dose (two 200 mg injections), then 200 mg every 2 weeks
• ≥60 kg: 600 mg loading dose (two 300 mg injections), then 300 mg every 2 weeks

Important Considerations for Atopic Dermatitis

• Dupilumab can be used with or without topical corticosteroids 1
• Topical calcineurin inhibitors should be reserved for problem areas only (face, neck, intertriginous and genital areas) 1
• The 300 mg every 2 weeks maintenance regimen is critical for sustained response—longer dosing intervals result in diminished efficacy 2
• For mild disease (Overall Assessment 2.0, <10% BSA), discontinuation with transition to optimized topical therapy is appropriate 3

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Asthma

For adults and adolescents ≥12 years with moderate-to-severe eosinophilic asthma, use either 400 mg loading dose (two 200 mg injections) followed by 200 mg every 2 weeks OR 600 mg loading dose (two 300 mg injections) followed by 300 mg every 2 weeks. 1

Special Asthma Populations

For patients with oral corticosteroid-dependent asthma OR co-morbid moderate-to-severe atopic dermatitis OR adults with co-morbid chronic rhinosinusitis with nasal polyps: 600 mg loading dose followed by 300 mg every 2 weeks 1

Pediatric Dosing for Asthma (Ages 6-11 years)

• 15 to <30 kg: 300 mg every 4 weeks (no loading dose) 1
• ≥30 kg: 200 mg every 2 weeks (no loading dose) 1
• If co-morbid moderate-to-severe atopic dermatitis exists, follow the atopic dermatitis dosing table which includes a loading dose 1

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Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)

For adults and adolescents ≥12 years with inadequately controlled CRSwNP, administer 300 mg every 2 weeks (no loading dose specified in FDA labeling). 1

Evidence Supporting CRSwNP Dosing

• The SINUS-24 and SINUS-52 trials demonstrated that 300 mg every 2 weeks significantly improved nasal polyp scores, SNOT-22, disease severity, nasal congestion, smell (UPSIT), and CT scores 4
• The Bachert 2016 study used a 600 mg loading dose followed by 300 mg weekly, showing significant improvements at 16 weeks 4, 5
• Improvements occurred regardless of comorbid asthma, NSAID-exacerbated respiratory disease, or previous nasal polyp surgery 6
• All patients should continue intranasal corticosteroids (mometasone 100 μg in each nostril twice daily) concurrently 4

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Other Indications

Eosinophilic Esophagitis (Ages ≥1 year, ≥15 kg)

• 15 to <30 kg: 200 mg every 2 weeks 1
• 30 to <40 kg: 300 mg every 2 weeks 1
• ≥40 kg: 300 mg every week 1

Prurigo Nodularis (Adults)

600 mg loading dose (two 300 mg injections), then 300 mg every 2 weeks 1

Chronic Obstructive Pulmonary Disease (Adults with eosinophilic phenotype)

300 mg every 2 weeks (no loading dose) 1

Chronic Spontaneous Urticaria

Adults: 600 mg loading dose, then 300 mg every 2 weeks 1

Adolescents 12-17 years: 1

• 30 to <60 kg: 400 mg loading dose, then 200 mg every 2 weeks
• ≥60 kg: 600 mg loading dose, then 300 mg every 2 weeks

Bullous Pemphigoid (Adults)

600 mg loading dose, then 300 mg every 2 weeks in combination with a tapering course of oral corticosteroids 1

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Administration Guidance

Route and Technique

• Administer subcutaneously into the thigh or abdomen (avoid 2 inches around navel) 1
• Upper arm may be used if a caregiver administers the injection 1
• Rotate injection sites with each dose 1
• Do NOT inject into tender, damaged, bruised, or scarred skin 1

Age-Appropriate Delivery Systems

• Pre-filled pen: approved for ages ≥2 years 1
• Pre-filled syringe: approved for ages ≥6 months 1
• Patients ≥12 years may self-inject under adult supervision 1
• Patients 6 months to <12 years require caregiver administration 1

Vaccination Considerations

Complete all age-appropriate vaccinations per current immunization guidelines prior to initiating dupilumab 1

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Safety Profile

Common Adverse Events

• Conjunctivitis (15.6%) and eye dryness (7.8%) are the most concerning ocular side effects—advise patients to report new or worsening eye symptoms 7
• Head and neck dermatitis (19.5%) is the most common dermatologic side effect 7
• Nasopharyngitis, injection site reactions, and headache occur frequently but are generally mild 7, 5
• Most side effects do not require discontinuation 7

Critical Warnings

• Discontinue immediately if hypersensitivity reactions occur (anaphylaxis, AGEP, serum sickness, angioedema) 1
• Do not abruptly discontinue systemic, topical, or inhaled corticosteroids upon dupilumab initiation—taper gradually if appropriate 1
• Monitor for eosinophilic conditions (vasculitic rash, worsening pulmonary symptoms, cardiac complications, kidney injury, neuropathy), especially when reducing oral corticosteroids 1
• Advise patients to report new-onset psoriasis or joint symptoms—consider discontinuation if symptoms persist or worsen 1