From the Guidelines
Immunoglobulin G (IgG) therapy and Dupixent (dupilumab) can be started concurrently if clinically indicated for their respective conditions, with careful consideration of potential ocular surface disorders associated with dupilumab therapy, as highlighted in a recent expert consensus 1.
Key Considerations
- For IgG therapy, typical starting doses range from 400-600 mg/kg administered intravenously every 3-4 weeks, with adjustments based on clinical response and IgG trough levels 1.
- Dupixent is typically initiated with a loading dose of 600 mg (two 300 mg injections) followed by 300 mg given subcutaneously every other week for adults with conditions like atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyps.
- These medications work through different mechanisms - IgG provides passive immunity for patients with immunodeficiencies, while Dupixent is a monoclonal antibody that blocks interleukin-4 and interleukin-13 signaling to reduce type 2 inflammation.
Monitoring and Adjustments
- Patients should be monitored for potential side effects from each medication, including infusion reactions, headache, and thrombotic events for IgG, and injection site reactions, conjunctivitis, and rare hypersensitivity reactions for Dupixent.
- Ocular surface disorders associated with dupilumab therapy, such as conjunctivitis, should be closely monitored, and alternative treatment options should be considered if significant risks to visual acuity or quality of life are identified 1.
Treatment Approach
- The treatment approach should be individualized based on the patient's specific condition, response to therapy, and potential risks associated with each medication.
- Regular clinical assessments are necessary to evaluate efficacy and adjust dosing as needed to minimize potential side effects and optimize treatment outcomes.
From the Research
Immunoglobulin G and Dupixent Start
- The use of Dupixent (dupilumab) in patients with Immunoglobulin G4-related disease (IgG4-RD) has been explored in several studies 2, 3.
- In a case report, dupilumab was used as an adjunct treatment for a patient with steroid-dependent IgG4-RD complicated by asthma, resulting in improved symptoms and reduced serum IgG4 levels 2.
- Another study reported a positive response to dupilumab in a patient with IgG4-RD-associated dermatitis with pruritus, with complete resolution of itch and remission of the rash 3.
- The mechanism of action of dupilumab, which inhibits the signaling of IL-4 and IL-13, may be relevant to the treatment of IgG4-RD, as these cytokines are involved in the pathogenesis of the disease 4.
- In addition to its use in IgG4-RD, dupilumab has been used to treat other conditions, such as atopic dermatitis, asthma, and nasal polyposis, and has been shown to reduce IgE levels and eosinophil-mediated lung inflammation 4, 5.
Key Findings
- Dupilumab may be a useful adjunctive treatment for patients with steroid-dependent IgG4-RD complicated by asthma 2.
- Dupilumab can improve symptoms and reduce serum IgG4 levels in patients with IgG4-RD 2, 3.
- The IL-4 and IL-13 pathway is involved in the pathogenesis of IgG4-RD, and dupilumab's mechanism of action may be relevant to the treatment of this disease 3, 4.