Dupilumab (Dupixent) is now approved to treat moderate-to-severe atopic dermatitis, the most common form of eczema, in adults whose eczema is not sufficiently controlled by topical therapies or who cannot receive topical therapies. It is administered weekly as a subcutaneous injection and can be used with or without topical corticosteroids.
Dupilumab's active ingredient is an antibody that binds to interleukin-4-specifically to the receptor alpha subunit that causes inflammation-and inhibits the inflammatory response. Dupilumab was established as safe and effective in three placebo-controlled clinical studies that evaluated a total of 2,119 adults with moderate-to-severe eczema. Generally, those who received dupilumab achieved a greater response, defined as clear or almost clear skin and decreased itching, after 16 weeks of treatment.
Dupilumab has not been studied in asthma. Patients who have asthma and have been prescribed dupilumab should not adjust or stop their asthma treatments unless recommended by their health care provider. Dupilumab may alter the level of cytochrome P-450 (CYP) isoenzymes and affect the metabolism of drugs dependent on those isoenzymes.
The most common adverse effects of dupilumab are injection site reactions, oral herpes, and eye and eyelid inflammation. Serious adverse effects include allergic reactions, conjunctivitis, and keratitis (inflammation of the cornea). Nurses should tell patients to contact a health care provider if they develop new or worsening eye symptoms, such as redness, itching, pain, or visual changes.
It is important to teach patients how to self-administer the prefilled syringe of dupilumab as a subcutaneous injection into the thigh, abdomen, or upper arm. The drug comes in two forms, with or without a needle shield. For specific instructions on administration, patients should consult the drug's labeling. Patients taking dupilumab should not receive live vaccines. Patients prescribed dupilumab should complete a drug assessment to determine if they are also taking drugs metabolized by the CYP isoenzyme system. If so, nurses should assess for the continued effectiveness of these drugs once dupilumab is started.
For complete prescribing information for dupilumab, see http://bit.ly/2pyOZbc.
Diane S. Aschenbrenner is an assistant professor at Notre Dame of Maryland University in Baltimore. She also coordinates Drug Watch: mailto:[email protected].