Dupilumab for eczema – Is it really the cure for inflammatory diseases?

Dupilumab (also known as Dupixent) is used to treat severe atopic eczema. It is a biologic drug and works in a way that is different from the other drugs used for treating eczema. They are taken in different ways like – injection (just below the skin, in the vein) and also orally. Dupilumab is the first biologic drug used to treat eczema and it comes as a ready-to-use syringe with a needle or it will be a pre-filled injector pen. There are other biologic treatments currently being developed to treat atopic eczema.

How does Dupilumab work?

Our body uses chemical messengers called interleukins (ILs) and it allows different parts of the immune system to communicate to fight off harmful bacteria. The immune system of people with atopic eczema overreacts to allergens like dust, mold, or pollen. This triggers the production of ILs that causes great inflammation. It is this reaction that leads to symptoms of eczema such as itchiness, dryness, and red or dark coloured patches depending on the person’s skin tone.

Biologics work by blocking ILs and this stops the immune system from overreacting. Dupilumab works on two specific ILs – IL-4 and IL-13. By blocking these ILs, the immune system won’t overreact and this will lead to less inflammation.

Immunosuppressive drugs like azathioprine, cyclosporin, methotrexate, and mycophenolate mofetil suppress different chemical messengers that control inflammation, whereas biologic drugs just suppress one or two chemical messengers. Drugs that suppress one or two chemical messengers have fewer side effects than normal immunosuppressive drugs.

What has research shown?

Research has shown that dupilumab can reduce the severity of eczema. It is also shown to reduce itchiness and improve sleep as well as the quality of life. Trial data results show that patients taking dupilumab no longer needed to apply as much topical steroid while taking the drug.

Is it available at the National Institute for Health and Care Excellence (NICE)?

Dupilumab has been approved by NICE for routine use by the NHS in England and Wales. It is also approved by the Scottish Medicines Consortium for NHS use in Scotland. Dupilumab is also available on NHS prescription to treat children (aged 6 years or above) with severe atopic eczema.

Who all can use it?

Dupilumab can be used for the treatment of adults and pediatric patients aged 6 months and older with moderate to severe eczema. To use dupilumab, you need to have tried at least one immunosuppressive drug like azathioprine, cyclosporin, mycophenolate mofetil, or methotrexate and the drug need not have worked effectively for you. You can be eligible to use dupilumab if you have been found to be ineligible for immunosuppressive drugs.

It is also more expensive than other drugs.

How is dupilumab administered?

It is given by an injection under the skin once every 2 weeks for patients 12 years and above using a pre-filled syringe, and once every 4 weeks in children (aged 6-11) using a pre-filled syringe. This pre-filled syringe delivers one dose. Patients can also administer dupilumab themselves after receiving proper training and instructions from professionals. Patients are supposed to inject into the thigh or abdomen (except for the 5cm part around the navel). Dupilumab must be stored in the fridge at-2.8°C, it can also be kept at room temperature (25°F) for 14 days.

How long should you use dupilumab?

Dupilumab is an ongoing treatment rather than a treatment that is done only for a short period of time. Patients are reviewed after 16 weeks and if the patient’s eczema has not responded adequately to dupilumab, then the treatment can be stopped.

Can people take dupilumab along with topical steroids and emollients?

Yes. people can still take dupilumab along with topical steroids and emollients.

Can you use dupilumab while pregnancy and breastfeeding?

No, you shouldn’t take dupilumab while breastfeeding and also when you’re pregnant as it causes a potential risk to the fetus. You can also consult a dermatologist about this.

What are the side effects of using dupilumab?

Side effects should be temporary and you make sure to consult your doctor if these side effects worsen or prolong for a long period of time.

  • Common side effects include eye inflammation (conjunctivitis), headaches, mouth or throat pain, and cold sores. There are serious eye-related problems like keratitis (inflammation of the cornea).
  • People who have asthma could experience worsening of their asthma.
  • Rare side effects include serum sickness-like reactions like fever, rash, and joint pain.
  • There are mild side effects like toothache, trouble sleeping, gastritis, and eosinophilia.

Warnings for dupilumab:

Allergic reaction: If you’ve had an allergic reaction to Dupilumab, you should not receive Dupilumab and you ask your doctor what other medications you can take.

Parasitic infections: If you have a parasitic infection, such as a tapeworm infection, it should be treated before you start Dupilumab. If you get a parasitic infection during the Dupilumab treatment, contact your doctor immediately. It’s possible to treat the infection while you’re still receiving Dupilumab, but if the infection doesn’t go away, you may need to stop receiving Dupilumab until the infection clears up.

Vaccines: you shouldn’t get live vaccines while you’re receiving Dupilumab because they could cause infections.

Hypersensitivity reactions:  Hypersensitivity reactions (like anaphylaxis, serum sickness or serum sickness-like reactions, angioedema, generalized urticaria, rash, erythema nodosum, and erythema multiforme) have been reported.

Acute Asthma Symptoms: do not use dupilumab to treat acute asthma symptoms, acute exacerbations, acute bronchospasm, or status asthmaticus.

Risk Associated with Abrupt Reduction of Corticosteroid Dosage: Do not discontinue corticosteroids (systemic, topical, or inhaled) abruptly upon initiation of dupilumab.

Joint pain: one main side effect of Dupilumab is joint pain. If your current joint pain has worsened while receiving dupilumab, then it is best a consult a doctor and get the treatment required.

Asthma attacks: dupilumab cannot relieve asthma attacks or breathing problems, it can only reduce the severity and number of asthma attacks.

Frequently asked questions:

Can dupilumab cause weight loss?

No, dupilumab does not cause weight loss.

Can dupilumab cause hair loss?

No, dupilumab does not cause hair loss. It is actually being used in a study to see if it can help with hair growth so it can be used to treat patients with alopecia areata.

Can dupilumab cause lymphoma?

Yes, there are studies showing that dupilumab administration has resulted in the development of cutaneous T- cell lymphoma (CTCL).

Can dupilumab cause psoriasis?

There have been an increasing amount of reports of onset psoriasis during the course of treatment of atopic dermatitis with Dupilumab.

Can I use alcohol while I’m taking Dupilumab?

Alcohol can have many interactions when taken with certain drugs, but dupilumab isn’t one of them.

Is dupilumab an immunosuppressant?

No, dupilumab is not an immunosuppressant. Instead, it’s a biologic drug, which works on very specific areas within your immune system.

Can dupilumab cause diarrhea or headache?

No, dupilumab does not cause diarrhea or headaches. These side effects were not reported during any case studies.