Five Things You May Not Know About Dupixent

1. More Than Just Eczema

Dupixent (dupilumab) was first approved for moderate-to-severe atopic dermatitis in adults in 2017. While many dermatology providers have become familiar with its efficacy in treating moderate-to-severe atopic dermatitis in patients 6 months and older, there are now several other indications. In 2018, it was approved for add-on maintenance treatment for uncontrolled moderate-to-severe eosinophilic or oral steroid dependent asthma for ages 6 years and older. In 2019, it gained approval as add-on maintenance treatment for uncontrolled chronic rhinosinusitis with nasal polyposis for ages 18 years and older. As of 2022, Dupixent has also been approved for both eosinophilic esophagitis for age 12 and older (and at least 40 kg), as well as prurigo nodularis for age 18 and older.

2. Not An Immunosuppressant

While Dupixent suppresses the production of specific inflammatory markers (specifically, IL-4 and IL-13), it does not broadly suppress the immune system. This is why no initial or routine blood work is required. In fact, in the prurigo nodularis phase 3 trials, patients with HIV were allowed to enroll in the trial.

3. No Live Vaccines

Any necessary live vaccines should be administered prior to initiating a patient on Dupixent. This also applies to other biologic therapies. Examples of live vaccines include MMR, varicella, rotavirus, intranasal influenza, smallpox, and yellow fever.

4. Side Effects (Other Than Eye Irritation)

Eye irritation, including conjunctivitis, blepharitis, keratitis, and dry eye syndrome, may occur in up to 10% of patients on Dupixent; however, resolution of these symptoms occurs in 80% of cases despite continued treatment. But did you know there are many other reported side effects? 1-9% of patients report injection site reactions, nasopharyngitis, and antibody development. While the numbers are low, others reported cold sores, eosinophilia, alopecia areata, gastritis and diarrhea, arthralgias or myalgias, and insomnia.

5. Reproductive Safety Unknown

Dupixent has a long half-life, taking up to 12 weeks to be undetectable, and we know human IgG crosses the placenta and into breast milk. The concentration will depend on maternal serum concentrations, placental integrity, fetal weight, and gestational age. What we don’t know is how Dupixnet affects a developing fetus or infant younger than 6 months old. However, when it comes to uncontrolled asthma, pregnant patients are at higher risk of perinatal mortality, preeclampsia, preterm birth, low birth weight infants, and gestational diabetes. These risks may outweigh the use of appropriately monitored asthma medications, including Dupixent. Only use if conventional therapies are insufficient; when possible, an agent other than Dupixent is recommended. Health care providers are encouraged to enroll exposed pregnant patients in the MotherToBaby Pregnancy Studies conducted by the Organization of Teratology Information Specialists (877-311-8972 or https://mothertobaby.org).

Clara Wilson, MS, PA-C, is a dermatology physician assistant at the Cleveland Clinic in Cleveland, Ohio. She treats medical and surgical patients with an emphasis on skin cancer prevention, detection and management. Clara is also an adjunct professor of dermatology at the Case Western Reserve University Physician Assistant Program, where she teaches both adult and pediatric dermatology.