Dupixent
Written By: Natalia Loomis
Atopic dermatitis, eczema, is an immune disorder that develops by 5 years of age. It causes extremely itchy rashes that come and go. Patients with atopic dermatitis have “super” sensitive skin and a decreased threshold foe irritation. The condition comes with oozing plaques of itchy skin and in chronic cases, thick elevated skin is present. Treatments for atopic dermatitis is centered around rehydration using emollients such as petroleum jelly and the cautious use of topical steroids to reduce inflammation and itching.
Dupixent (dupilumab) is new treatment for Atopic dermatitis developed by Sanofi Genzyme. Dupixent is a biologic that targets the underlying source of inflammation, healing the skin from within; a human monoclonal IgG4 antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling by specifically binding to the IL-4Rα subunit shared by the IL-4 and IL-13 receptor complexes. Dupilumab inhibits IL-4 signaling via the Type I receptor and both IL-4 and IL-13 signaling through the Type II receptor. Within the immune system, IL-4 perpetuates the type 2 inflammatory cascade and its effects through a positive feedback loop, this drives Th2 differentiation. IL 3 and Il-4 play roles in IgE production and B cell class switching. They both increase vascular adhesion and permeability. Dupixent helps to repair the skin by targeting a key source of type 2 inflammation specifically targeting IL-4 and Il-3 signaling to reduce epidermal hyperplasia, modify lesion skin appearance, and modulate genes related to the epidermal pathology in atopic dermatitis. Dupixent is not an immunosuppressant or a steroid and requires no initial lab testing or ongoing lab monitoring.
Dupixent comes in 200mg and 300mg injections using weight-based dosing. Your initial dose of Dupixent is 2 injections under the skin at different injection sites. After, it is taken as 1 injection site every 2 weeks or every 4 weeks depending on your age and weight. If your dose schedule is every other week and you miss a dose of DUPIXENT: Give the DUPIXENT injection within 7 days from the missed dose, then continue with your original schedule. If the missed dose is not given within 7 days, wait until the next scheduled dose to give your DUPIXENT injection. If your dose schedule is every 4 weeks and you miss a dose of DUPIXENT: Give the DUPIXENT injection within 7 days from the missed dose, then continue with your original schedule. If the missed dose is not given within 7 days, start a new every 4-week dose schedule from the time you remember to take your DUPIXENT injection.
As of right now, Dupixent is not recommended in pregnant women, or those who are breast feeding as no studies have been conducted to know whether Dupixent is harmful to the unborn baby. The most common side effect is allergic site reaction/ hypersensitivity.
References:
(1) MOA: Mechanism of Action. DUPIXENT® (dupilumab) Mechanism of Action. https://www.dupixenthcp.com/atopicdermatitis/about/mechanism-of-action. Accessed June 3, 2021.
Dupixent.Package insert. Sanofi Genzyme. 2021.
