Dupilumab

# Dupilumab ## Overview - **Classification**: Interleukin-4 receptor alpha antagonist; Monoclonal antibody - **Mechanism**: Inhibits IL-4 and IL-13 signaling by binding to the IL-4Rα subunit, reducing type 2 inflammation. ## Primary Indications 1. **Atopic Dermatitis (moderate-to-severe)** - Adults and pediatric patients 2. **Asthma (moderate-to-severe eosinophilic or oral corticosteroid-dependent)** - Adults and pediatric patients 3. **Chronic Rhinosinusitis with Nasal Polyposis (CRSwNP)** - Adults only 4. **Eosinophilic Esophagitis (EoE)** - Adults and pediatric patients (≥1 year) 5. **Prurigo Nodularis (PN)** - Adults only ## Adult Dosing ### Atopic Dermatitis, Prurigo Nodularis - **Initial Dose**: **600 mg** subcutaneously (two 300 mg injections) - **Maintenance Dose**: **300 mg** subcutaneously every 2 weeks - **Route**: Subcutaneous (SC) ### Asthma, Chronic Rhinosinusitis with Nasal Polyposis - **Maintenance Dose**: **300 mg** subcutaneously every 2 weeks - **Route**: Subcutaneous (SC) - **Note**: No loading dose for these indications. ### Eosinophilic Esophagitis - **Dose**: **300 mg** subcutaneously every week - **Route**: Subcutaneous (SC) ### Dose Adjustments - **Renal Impairment**: No dose adjustment needed. - **Hepatic Impairment**: No dose adjustment needed. - **Elderly Patients**: No specific dose adjustment needed. ## Pediatric Dosing ### Atopic Dermatitis **Children 6 months to <6 years** - **15 to <30 kg**: - **Initial Dose**: **200 mg** SC - **Maintenance Dose**: **200 mg** SC every 4 weeks - **5 to <15 kg**: - **Initial Dose**: **200 mg** SC - **Maintenance Dose**: **200 mg** SC every 4 weeks **Children 6 to <12 years (<60 kg)** - **15 to <30 kg**: - **Initial Dose**: **300 mg** SC - **Maintenance Dose**: **300 mg** SC every 4 weeks - **30 to <60 kg**: - **Initial Dose**: **400 mg** SC (two 200 mg injections) - **Maintenance Dose**: **200 mg** SC every 2 weeks **Children 6 to <12 years (≥60 kg)** - **Initial Dose**: **600 mg** SC (two 300 mg injections) - **Maintenance Dose**: **300 mg** SC every 2 weeks **Adolescents 12 to <18 years** - **<60 kg**: - **Initial Dose**: **400 mg** SC (two 200 mg injections) - **Maintenance Dose**: **200 mg** SC every 2 weeks - **≥60 kg**: - **Initial Dose**: **600 mg** SC (two 300 mg injections) - **Maintenance Dose**: **300 mg** SC every 2 weeks ### Asthma **Children 6 to <12 years** - **15 to <30 kg**: **100 mg** SC every 2 weeks - **30 to <60 kg**: **200 mg** SC every 2 weeks - **≥60 kg**: **200 mg** SC every 2 weeks - **Note**: No loading dose for asthma. **Adolescents 12 to <18 years** - **Maintenance Dose**: **200 mg** SC every 2 weeks (or **300 mg** SC every 2 weeks for severe asthma with oral corticosteroid dependence) - **Note**: No loading dose. ### Eosinophilic Esophagitis **Children 1 year to 11 years (≥15 kg)** - **15 kg to <30 kg**: **300 mg** SC every 2 weeks - **≥30 kg**: **300 mg** SC every week **Adolescents 12 to 17 years** - **Dose**: **300 mg** SC every week - **Route**: Subcutaneous (SC) ## Safety Information ### Contraindications - **Absolute**: Known hypersensitivity to dupilumab or any excipients. ### Common Adverse Effects - **Very Common (>10%)**: Injection site reactions (erythema, swelling), conjunctivitis, oral herpes. - **Common (1-10%)**: Eosinophilia, arthralgia, dry eye, blepharitis, blurred vision. - **Serious but Rare**: Anaphylaxis, hypersensitivity reactions, facial swelling, serum sickness. ### Key Drug Interactions - **Live Vaccines**: Avoid concurrent administration with dupilumab due to lack of data on efficacy and safety. - **Immunosuppressants (e.g., OCS, methotrexate)**: Systemic corticosteroids can be tapered under medical supervision, but too rapid withdrawal may exacerbate underlying disease. ## Monitoring & Follow-up - **Before Treatment**: Assess for pre-existing helminth infections if high-risk region; treat before dupilumab initiation. - **During Treatment**: - Monitor for signs/symptoms of ophthalmic adverse events (e.g., conjunctivitis, keratitis). - Monitor for signs/symptoms of hypersensitivity reactions. - Monitor for new or worsening joint symptoms. - Periodic assessment of clinical response. - **Clinical Signs**: Swelling, redness, itching at injection site; eye redness, irritation, changes in vision. ## Clinical Pearls - 💡 **Tip 1**: Administer doses into the thigh, abdomen, or upper arm. Rotate injection sites. - 💡 **Tip 2**: Store in refrigerator (2-8°C, 36-46°F) in original carton; protect from light. May be kept at room temperature (up to 25°C, 77°F) for up to 14 days. - 💡 **Tip 3**: Counsel patients on proper self-injection technique if applicable, and recognition of hypersensitivity reactions. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.