Dupilumab Medication: Uses, Dosage, & Side Effects Explained

Dupilumab is a prescription medication that has helped many people manage certain long-term health conditions. If you or a loved one struggles with skin irritation, breathing problems, or inflammation, your doctor may have mentioned dupilumab as a treatment option. 

This medication differs from many traditional treatments because it targets the root causes of inflammation in the body.

This article explains what dupilumab is used for, how it works, typical dosages, possible side effects, and other important details. Whether you're a patient, caregiver, or healthcare professional, this guide will help you better understand dupilumab.

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What is Dupilumab?

Dupilumab is a type of medicine known as a biologic. Biologics are treatments made from living cells that target specific parts of the immune system. 

Dupilumab blocks two proteins in the body, IL-4 and IL-13, which are involved in inflammation. Reducing inflammation helps improve symptoms of certain chronic (long-term) conditions.

This medication is typically given as an injection under the skin (subcutaneous injection). 

Dupilumab is not a steroid, which makes it a good option for people who want an alternative to steroid-based treatments. It is also not a tablet and must be injected at home or in a medical setting.

Doctors prescribe dupilumab for conditions where the immune system overreacts and causes ongoing inflammation. Some examples include skin problems, such as eczema, and breathing issues, such as asthma. 

While dupilumab doesn't cure these conditions, it may help improve symptoms and make them easier to manage.

Researchers are exploring how dupilumab might help with other health conditions. Some of these conditions include:

• Chronic Obstructive Pulmonary Disease (COPD)
• Allergic fungal sinusitis
• Food allergies
• Other skin conditions like chronic urticaria (hives)

These emerging indications are still being studied, so they are not FDA-approved. However, they show promise in expanding dupilumab's use to help more patients in the future.

Clinical Uses of Dupilumab

Dupilumab is a medication prescribed for a range of chronic inflammatory conditions caused by an overactive immune system. Here are the most common conditions it is used to treat.

Skin Conditions

Skin conditions involving inflammation can cause severe itching, discomfort, and visible symptoms that may not respond to typical treatments like creams or steroids. 

Dupilumab has been approved to help manage some of these challenging skin disorders.

Atopic Dermatitis (Eczema)

Atopic dermatitis (eczema) is a chronic skin condition that causes dryness, redness, itching, and inflammation. It can be especially severe for individuals whose symptoms do not respond well to creams, ointments, or oral medications. 

Dupilumab is often prescribed for moderate-to-severe eczema as it may reduce inflammation, relieve itching, and improve the skin's appearance. Individual treatment responses to treatment can vary, and a healthcare provider should guide its use.

Prurigo Nodularis

Prurigo nodularis is a chronic skin condition that causes hard, itchy lumps on the skin. For many people, these lumps are resistant to traditional treatments. 

Dupilumab has recently been approved to treat this condition and has been shown to reduce itching and improve skin quality, giving patients much-needed relief.

Respiratory Conditions

Respiratory conditions like asthma and nasal polyps can significantly affect breathing and quality of life. 

Dupilumab offers an option for people who struggle with traditional treatments, targeting the inflammation that drives these conditions.

Asthma

Dupilumab is an effective treatment for moderate-to-severe asthma, especially eosinophilic asthma, which is associated with high levels of eosinophils, a type of immune cell involved in inflammation. 

Dupilumab reduces inflammation in the airways, improves lung function, and lowers the risk of asthma attacks. It is also helpful for patients who depend on oral steroids by reducing their need for these medications.

Chronic Rhinosinusitis with Nasal Polyposis

Nasal polyps are soft, noncancerous growths inside the nasal passages that can cause chronic congestion, difficulty breathing, and loss of smell. 

For people whose symptoms persist despite surgery or other treatments, dupilumab can help shrink polyps, relieve congestion, and restore the sense of smell.

Other Conditions

Dupilumab is also used to treat conditions outside the skin and respiratory system. It helps reduce inflammation in other areas of the body and is currently being studied for additional uses.

Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis is when the esophagus becomes inflamed due to an overactive immune response. This inflammation can make swallowing painful or difficult. 

Dupilumab has been approved to treat this condition by managing inflammation in the esophagus and improving swallowing.

Before starting dupilumab, consult a healthcare provider to assess whether it is the right treatment option.

Dupilumab Dosing and Administration

Understanding the dosage and administration of dupilumab is essential for achieving the best possible results while minimizing potential risks. 

The dosing schedule varies based on the treated condition, and dupilumab is typically administered through an injection under the skin.

Dosing for Atopic Dermatitis

Adults:

• Initial Dose: 600 mg (administered as two 300 mg injections).
• Subsequent Doses: 300 mg every other week (Q2W).

Pediatric Patients (Aged 6 to 17 Years):

• 15 kg to less than 30 kg: 600 mg initially (administered as two 300 mg injections), followed by 300 mg every 4 weeks.
• 30 kg to less than 60 kg: 400 mg initially (administered as two 200 mg injections), followed by one injection of 200 mg every other week.
• 60 kg or more: 600 mg initially (administered as two 300 mg injections), followed by 300 mg every other week.

Pediatric Patients (Aged 6 months to 5 Years):

• 5 kg to less than 15 kg: 200 mg every 4 weeks.
• 15 kg to less than 30 kg: 300mg every 4 weeks.

Dosing for Asthma

Adults and Pediatric Patients (Aged 12 Years and Older):

• 400 mg (two 200 mg injections) followed by 200mg every other week.

OR

• 600 mg (two 300 mg injections) followed by 300 mg every other week.

Pediatric Patients 6 to 11 Years of Age:

• 15 kg to less than 30 kg: 100 mg every other week or 300 mg every four weeks.
• 30 kg or more: 200 mg every other week.

Dosing for Chronic Rhinosinusitis with Nasal Polyps

The recommended dosage for adults is consistently set at 300 mg every other week.

Dosing for Eosinophilic Esophagitis

For adults and children aged one year and older, weight-based dosing applies:

• 15 kg to less than 30 kg: 200 mg every other week.
• 30 kg to less than 40 kg: 300 mg every other week.
• More than 40 kg: 300 mg weekly.

If A Dose is Missed

For doses scheduled every other week, the patient should receive the dose within seven days of the missed dose. If the dose is not administered within this timeframe, the patient should wait until the next scheduled dose.

How to Administer Dupilumab

Dupilumab is administered as a subcutaneous injection, injected just under the skin. Many patients self-administer dupilumab at home after receiving proper training. 

Here's a simple guide to ensure safe and effective administration:

1. Preparation
   • Wash your hands thoroughly with soap and water.
   • Remove the prefilled syringe or pen from the refrigerator and let it warm to room temperature for about 45 minutes. Do not heat it in any other way.
   • Inspect the syringe or pen for clarity; the solution should be clear to slightly yellow and free of particles.
2. Choose an Injection Site
   • Common injection sites include the thigh, stomach (avoiding the area around the belly button), or the outer part of the upper arm (if someone else is administering the injection).
   • Rotate the injection site each time to avoid skin irritation.
3. Inject the Medication
   • Clean the area with an alcohol swab and let it dry.
   • Hold the syringe or pen as instructed by your healthcare provider. Insert the needle at a 45-degree angle.
   • Push the plunger or activate the pen until the dose is entirely administered.
4. Dispose of the Syringe or Pen
   • Safely dispose of the used pen or syringe in a sharps container to avoid injury.

If you are unsure about any steps, your doctor or pharmacist can provide additional guidance.

Monitoring During Treatment

While dupilumab does not usually require routine blood tests, regular follow-up with your healthcare provider is essential. Your doctor may monitor for improvement in symptoms and any potential side effects. 

In rare cases, blood tests might be ordered to assess for signs of infection or other complications. Be sure to notify your healthcare provider of any unusual symptoms you experience during treatment.

Benefits and Risks of Dupilumab

Like any medication, dupilumab has its advantages and potential risks. Many patients report noticeable symptom improvements; however, individual outcomes can vary. 

As discussed with your healthcare provider, weighing the potential benefits against the risks is critical.

Key Benefits

Dupilumab offers several advantages for people with chronic inflammatory conditions:

• Rapid Symptom Relief: Many patients experience relief within a few weeks of starting treatment, including reduced itching, better breathing, or improved swallowing, depending on the condition.
• Improved Quality of Life: By addressing the root causes of inflammation, dupilumab can improve daily functioning and overall well-being.
• Long-Term Efficacy and Safety: Clinical trials and real-world studies have shown that dupilumab remains effective and safe for long-term use in managing chronic conditions.

Common and Rare Side Effects

While dupilumab is generally well-tolerated, side effects can occur. Most are mild, but some people may experience more serious reactions.

Common side effects include:

• Injection site reactions (redness, swelling)
• Conjunctivitis (pink eye)
• Cold sores (oral herpes)
• Upper respiratory infections

Rare side effects include:

• Severe allergic reactions (anaphylaxis)
• Eye inflammation (keratitis)
• Eosinophilia (high levels of specific white blood cells)
• Joint pain

If you notice severe or unusual symptoms, contact your healthcare provider immediately.

Contraindications and Precautions

Dupilumab is not suitable for everyone. Your doctor will evaluate whether it is the right option for you. 

People who should avoid Dupilumab or use it cautiously include:

• Patients with Known Allergies to Dupilumab: Anyone with a history of allergic reactions to this medication or its ingredients should avoid use.
• Pregnant or Breastfeeding Individuals: While studies are limited, dupilumab should only be used during pregnancy or breastfeeding if the potential benefits outweigh the risks.

Always discuss your complete medical history with your doctor before starting Dupilumab to ensure it is safe for your unique situation.

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Key Takeaways

• Dupilumab is a biologic medication that targets specific immune proteins (IL-4 and IL-13) to reduce inflammation and manage chronic conditions such as eczema, asthma, and eosinophilic esophagitis.
• It is administered as a subcutaneous injection with dosages and frequency varying based on the condition being treated, making it an effective alternative to steroid-based therapies.
• Dupilumab provides significant symptom relief and improves quality of life but may cause mild side effects like injection site reactions or conjunctivitis, with rare risks such as severe allergic reactions or eye inflammation.
• Although the medication is expensive, insurance plans often cover it, and financial assistance programs like Dupixent MyWay can help reduce costs.
• Ongoing research explores dupilumab's potential to treat other conditions, including chronic hives, food allergies, and COPD, but these uses are not yet FDA-approved.