What You Should Know About Dupilumab Dupixent

If you have a chronic inflammatory condition like eczema, asthma or chronic rhinosinusitis with nasal polyps (CRSwNP), you know it can be challenging to live with discomfort, trouble breathing or congestion. Dupilumab, an injected medication known by its brand name Dupixent, may help.

Dupilumab is a type of medication known as a monoclonal antibody, which targets and blocks two proteins in the body that cause inflammation. Reducing inflammation may help control symptoms and prevent flare-ups. It is a biologic medication, which means it is made from living cells and not chemically synthesized.

Dupilumab may provide relief if other treatments have fallen short or are unsuitable.

“Dupixent does not carry the same infection risks that many other immunosuppressive medications do because it doesn’t broadly suppress the immune system. This makes it relatively safer in terms of infection risk compared to some other biologic therapies,” said Paul Thompson, a pharmacist with Banner Pharmacy Services. He explained more about this medication.

Benefits of dupilumab

Dupixent offers several important benefits for people with these chronic inflammatory conditions:

Atopic dermatitis (eczema): It may help reduce itching, redness and skin thickening. Many people with moderate to severe eczema that hasn’t responded to other treatments have clearer skin, fewer flareups, improved sleep, more comfort and better quality of life with Dupixent.
Asthma: It may decrease asthma attacks and improve breathing and lung function for people with moderate to severe asthma that’s not well-controlled with steroids or other treatments. It may lead to fewer emergency visits and hospitalizations and make physical activity and daily tasks easier.
CRSwNP: It may reduce nasal congestion and the size of nasal polyps, making it easier to breathe. Some people also notice an improved sense of smell. It may be an alternative to surgery or an option for people who have had surgery without long-term success.

Dupixent can control symptoms long-term, reducing or eliminating the need for oral steroids which can have serious side effects when used long-term. “Over time, steroid use can cause weight gain, eye problems like cataracts and osteoporosis,” Dr. Thompson said.

“Dupilumab doesn’t require immune suppression or routine blood work, which is an advantage over some other biologics,” he said. “It may take several weeks to see significant improvement, so patience is key.”

The medication is being studied to see if it may be used to treat other inflammatory conditions in the future.

How to use dupilumab

Dupixent is injected just under the skin and gets absorbed directly into the bloodstream. Your health care provider will show you how to give yourself the injections at home. “Proper technique and site rotation are essential,” Dr. Thompson said.

It’s usually injected into the thigh or abdomen if you do it yourself and the upper arm if you give the injection to someone else. You should change injection sites with every dose to reduce the risk of irritation.

Most adults with atopic dermatitis or asthma start with two 300-milligram injections on the same day, followed by 300 milligrams every other week. For chronic rhinosinusitis with nasal polyps, the dosing may be a little bit different. Your health care provider will instruct you.

“I recommend patients follow their prescribed dosing schedule carefully and remain consistent with injections,” Dr. Thompson said. If you miss doses, your treatment may be less effective, and your symptoms may return.

Tips for storage and injection

Store Dupixent in the refrigerator at a temperature of 36°F to 46°F (2°C to 8°C). You can keep the medication at room temperature (up to 77°F or 25°C) for up to 14 days if you need to.

If Dupixent has been out of the refrigerator for more than 14 days, don’t use it. Keep Dupixent away from heat and light and do not freeze it.

Here’s how to administer it:

Before you inject the medication, take the syringe or pen out of the refrigerator for about 45 minutes so it can reach room temperature.
Don’t shake the syringe or pen.
Clean the injection site with an alcohol swab and let it dry.
Hold the syringe or pen at a 90-degree angle to the skin and inject the medication as instructed. Dispose of the needle safely in a sharps container.

Possible side effects of dupilumab

If you take Dupixent, you should be aware of some possible side effects:

Injection site reactions: You may have redness, swelling or pain at the place where you inject the medication. These reactions are usually mild and clear up within a few days. A cool compress can help.
Conjunctivitis (pink eye): Pink eye is an eye inflammation that can cause redness, itching and discharge. It’s usually mild but tell your health care provider if it doesn’t clear up or gets worse.
Dry eye: You may notice a gritty feeling in the eyes or blurred vision. Lubricating eye drops can help.

If you have any of these side effects, keep track of how severe they are and how long they last. You can share this information with your provider.

Less common but more serious side effects include:

Allergic reactions: Symptoms can include rash, itching, severe dizziness, trouble breathing or swelling of the face, tongue or throat. If you notice these symptoms, get medical attention immediately.
Eosinophilia (increase in a type of white blood cell): This condition can cause fever, chest pain or an increase in breathing problems. If you notice any unusual symptoms, contact your health care provider promptly.
New or worsening joint pain: If you have joint pain, discuss it with your health care provider.

Be sure to see your health care provider regularly to check how well the medication is working, decide whether you need to adjust your treatment and watch for signs of side effects you might not notice right away, like changes in blood counts or early signs of infection.

Have regular eye exams as well, since Dupixent can cause eye conditions or make them worse. “If you have eye health issues, prompt referral to an ophthalmologist can prevent complications,” Dr. Thompson said.

If you have serious side effects, contact your provider right away. They can help you manage them or adjust your treatment plan. Don’t stop taking Dupixent without medical advice.

If you have signs of a severe allergic reaction, such as difficulty breathing, swelling or severe dizziness, get emergency medical attention immediately.

Precautions and warnings

Some people should not take Dupixent or should be cautious with it:

Don’t take Dupixent if you’re allergic to it or any of its ingredients.
Talk to your provider before taking Dupixent if you have eye conditions such as conjunctivitis or keratitis. You may be able to take it, but you’ll need close monitoring.
Don’t start taking Dupixent if you have a severe infection such as tuberculosis or an untreated bacterial, fungal or viral infection. You shouldn’t take it until the infection is under control.
If you need any live vaccines, such as the measles, mumps and rubella (MMR) vaccine, you’ll probably want to get the vaccine first. Dupixent can interfere with the vaccine’s effectiveness.
Since Dupixent is a biologic medication that affects the immune system, taking it with other biologics or immunosuppressants can reduce its effectiveness. Make sure your provider knows about all the medications, supplements and over-the-counter (OTC) drugs you are taking.

Lifestyle tips for managing chronic inflammatory conditions

Along with Dupixent, these lifestyle tips can help you keep your symptoms under control.

Atopic dermatitis

Moisturize at least twice daily with a thick, fragrance-free moisturizer.
Clean your skin with mild, soap-free cleansers that don’t strip the natural oils from your skin. Use lukewarm water (not hot) for baths and showers.
Avoid harsh soaps, fragrances and fabrics like wool that can cause eczema flare-ups. Choose soft, breathable fabrics like cotton for your clothing.
Reduce stress with deep breathing, yoga or meditation to help keep your symptoms under control.

Asthma

Avoid triggers like pollen, pet dander, dust mites, tobacco smoke, cold air and respiratory infections.
Use a peak flow meter to measure how well air moves out of your lungs. Using a peak flow meter can help you monitor your asthma and spot early signs of an attack.
Reduce indoor allergens by keeping your home clean and well-ventilated. Regularly wash bedding in hot water, use allergen-proof covers on mattresses and pillows and vacuum frequently with a HEPA-filtered vacuum.
Work with your health care provider to develop a personalized asthma action plan that outlines how to manage your symptoms, what medications to take and when to seek medical help.

Chronic rhinosinusitis with nasal polyps (CRSwNP)

Use a saline nasal rinse daily to help clear out mucus and allergens, reduce inflammation and improve drainage.
Avoid irritants like smoke, strong odors and pollution and consider using an air purifier in your home.
Use a humidifier in your bedroom, especially during dry seasons.
Drink plenty of water to help thin mucus and make it easier to clear your sinuses.

The bottom line

Dupilumab (Dupixent) is an injected medication that may help treat atopic dermatitis, asthma and chronic rhinosinusitis with nasal polyps. It may lower your risk of infection and eliminate the need to take steroids. But it can cause some serious side effects and it’s not the right option for everyone.

Your health care provider or an expert at Banner Health can review your symptoms and health history and help you decide if Dupixent is a good option for you.

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Dupilumab (Dupixent): What You Need to Know