Can Dupixent (dupilumab) be administered weekly?

From the Guidelines

Dupixent (dupilumab) should not be used weekly for most conditions, as the standard dosing regimen is an initial loading dose of 600 mg followed by 300 mg given every two weeks as a subcutaneous injection. The biweekly dosing schedule is designed to maintain therapeutic blood levels of the medication based on its half-life and mechanism of action, as seen in studies such as 1. Dupixent works by blocking interleukin-4 and interleukin-13 signaling, which are key drivers of type 2 inflammation in conditions like atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyps.

Key Points to Consider

• The standard dosing regimen for adults with atopic dermatitis, asthma, or chronic rhinosinusitis with nasal polyps is an initial loading dose of 600 mg (two 300 mg injections) followed by 300 mg given every two weeks as a subcutaneous injection, as supported by studies like 1.
• For adolescents and some adults with atopic dermatitis, the dosing may be adjusted based on weight, but still maintains the every-two-week schedule.
• The two-week interval allows for consistent suppression of inflammatory pathways while minimizing potential side effects, as noted in studies evaluating dupilumab's efficacy in conditions like CRSwNP 1.
• Patients should follow their healthcare provider's specific instructions regarding dosing schedule and not adjust to weekly administration without medical guidance, as this could potentially increase the risk of side effects without providing additional therapeutic benefit.

Evidence Supporting the Recommendation

• Studies such as 1 demonstrate the efficacy of dupilumab in improving outcomes for patients with severe CRSwNP when administered every two weeks.
• The european position paper on rhinosinusitis and nasal polyps 2020, as cited in 1 and 1, provides further evidence for the standard dosing regimen and its benefits in managing rhinosinusitis disease severity and related symptoms.

From the FDA Drug Label

In a clinical study, adult subjects with AD were treated once weekly for 16 weeks with 300 mg of DUPIXENT (twice the recommended dosing frequency). The FDA drug label does mention a study where DuPixent was used weekly, but it was at twice the recommended dosing frequency.

• Recommended dosing frequency is not weekly.
• The label does not provide information to support the use of DuPixent weekly at the recommended dose. 2

From the Research

Dupixent Administration Frequency

• The studies provided do not explicitly state that DuPixent can be used weekly 3, 4, 5, 6, 7.
• However, the standard administration frequency of Dupixent (dupilumab) is every 2 weeks, as mentioned in the study published in 2020 3.
• There is no evidence to suggest that weekly administration of Dupixent is recommended or approved.

Dupixent Efficacy and Safety

• Dupixent has been shown to be effective in treating chronic rhinosinusitis with nasal polyps (CRSwNP) and other conditions such as atopic dermatitis and asthma 3, 5, 7.
• The safety profile of Dupixent is generally considered to be high, with transient increases in blood eosinophil counts observed in some patients 6.
• Dermatologic side effects have been reported in patients treated with Dupixent for CRSwNP, including psoriasis-like dermatitis and rosacea-like folliculitis 4.

Clinical Considerations

• The decision to use Dupixent should be based on individual patient needs and medical history 6.
• Patients with concomitant atopic dermatitis and CRSwNP may benefit from treatment with Dupixent, as it has been shown to improve symptoms of both conditions 7.