The Dupilumab Injection: What You Should Know About this Eczema Treatment
Dupilumab injection is one of the treatment options available for eczema. This condition encompasses several skin conditions, such as atopic dermatitis, which occurs in up to 25% of children and 10% of adults.
Although its causes are still under investigation, it has been found to have an immune component. This is why it’s sometimes difficult to manage with conventional treatments. For this reason, we’re going to tell you what this injectable drug consists of, how it works, and what its possible adverse effects are. Read on to learn more!
About eczema
Eczema is a chronic inflammation of the skin characterized by an alteration of its barrier function. This situation leads to the appearance of red and scaly plaques that generate great itching and even pain.
Without timely and adequate intervention, it cane even lead to anxiety, insomnia, and depression. Consequently, it affects the sufferer’s quality of life.
It’s important to note that both the distribution and the shape of the lesions vary with the age of the person.
What is the dupilumab injection?
Dupilumab is a human monoclonal antibody, which is obtained through recombinant DNA technology. The process leads to the production of a single type of antibody, designed to block a cellular receptor responsible for triggering the inflammatory response in atopy.
In this way, the dupilumab injection does not allow two molecules – called interleukins (IL-4 and IL-13) – to bind to the receptor. The result of this action is that the signals necessary for the immune system to activate an inflammatory cascade cannot be generated.
However, because the mechanism that causes eczema is not fully understood, this drug cannot be proposed as a perfect therapy. Therefore, despite being approved, further studies are needed to better understand both the drug and the disease.
You might like another great article: Best Remedies to Treat Eczema
When this injection can be used
This monoclonal antibody is the first biological therapy approved to treat atopic dermatitis. However, its use is only indicated in patients with moderate to severe disease in whom conventional topical agents – such as corticosteroids or calcineurin inhibitors – have not been effective.
It can be prescribed in a small group of people in whom these treatments are contraindicated.
On the other hand, dupilumab injection has been shown to be useful in the management of asthma. Studies suggest that it can improve lung function and decrease the severity of exacerbations.
Similarly, it can be used in patients with nasal polyps, whose management with local steroids is unsuccessful. On the other hand, other indications for the drug, such as eosinophilic esophagitis, are still under investigation.
How is the dupilumab injection used?
The drug comes under the trade name “Dupixent®“, in the form of a pre-filled syringe with a single dose of 300 mg. It is administered by subcutaneous injection, which can be applied in the thigh, arm, or abdomen.
The recommended dosage schedule for adults consists of an initial dose of 600 mg, i.e. two injections in two different sites, followed by doses of 300 mg every two weeks.
The duration of treatment should be prolonged, although this is stipulated by the treating physician. Its effects are observed after a few weeks. Likewise, its stable concentrations are registered after 16 weeks from its initiation.
Therefore, this treatment is not indicated in patients with severe acute exacerbations that require rapid management of the lesions.
General recommendations
It is important to rotate the injection site to avoid the appearance of local complications. The use of emollients and prevention of flare-up triggers are useful to improve skin conditions and reduce exacerbations.
On the other hand, drug concentrations are reduced at higher body weight. It’s not recommended to increase the dose in overweight or obese patients.
Dupilumab: Alone or in combination with other drugs?
The studies conducted with Dupixent® included both its use as an isolated drug (monotherapy) and its administration associated with other drugs, especially topical steroids.
The conclusion of these investigations shows an advantage in the combination of both treatments, since an improvement of the lesions and of the most bothersome symptoms, such as pruritus (itching), was achieved.
Side effects of the dupilumab injection
So far, the information available on dupilumab as a treatment for moderate to severe atopic dermatitis does not show a high incidence of serious adverse reactions.
Therefore, its use is currently considered safe and well-tolerated by patients. Despite this, the drug does have some undesirable effects, such as the following:
- Inoculation site reactions
- Headaches
- Conjunctivitis
- Nasopharyngitis
- Exacerbations of eczema
- Skin and soft tissue infections
- Hypersensitivity reactions, including serum sickness
In the presence of ocular symptoms, it’s important to evaluate and treat the patient appropriately. If necessary, referral to a specialist should be made, since the mechanism by which the monoclonal antibody produces this condition is not known.
Long-term monitoring of the drug is also desirable. This is in order to detect those adverse effects that may have gone unnoticed and others that arise from prolonged use.
The key is to improve knowledge of the safety and tolerance of dupilumab.
Contraindications of biologic treatments for eczema
Due to the unknown risk of dupilumab in pregnancy, its use is contraindicated in this stage. Its simultaneous use with live virus vaccines is also not recommended. If immunization with this type of biological product is necessary, dupilumab should not be used.
For the time being, no effects on the immunity produced by other types of vaccines have been detected. Therefore, these can be administered in patients who are under a schedule of injections with Dupixent®.
Are there other therapeutic options for the management of eczema?
Among the alternatives for treating atopic dermatitis that does not respond to topical drugs are immunosuppressants. The most prominent are the following:
- Cyclosporine
- Azathioprine
- Methotrexate
- Mycophenolate mofetil
However, these drugs have a high level of toxicity. Therefore, it’s not advisable to use them for a prolonged period of time.
In addition, the indication of immunosuppressants leads to a high risk of infection because their effect reduces the capacity of the immune response. In fact, some of these drugs are not approved to treat atopic dermatitis.
You may be interested in reading this, too: How Doctors Treat Autoimmune Diseases
Storage and precautions
Dupilumab should be kept in the refrigerator, protected from sunlight. The recommended storage temperature is between 2 and 8°C, but it can remain stable at room temperature for two weeks.
The use of this drug in children has shown a similar result to that in adults, but it is necessary to adjust the dosage of the scheme. However, research on pediatric patients is scarce and should be expanded.
Finally, since it’s a monoclonal antibody, it’s a drug whose use requires extreme caution. Both prescription and patient follow-up should be under the strict supervision of an experienced physician.
Also, since its introduction in the market as a treatment for eczema is recent, more studies are needed.
All cited sources were thoroughly reviewed by our team to ensure their quality, reliability, currency, and validity. The bibliography of this article was considered reliable and of academic or scientific accuracy.
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