How does Dupixent work and what is its mechanism of action?

Dupixent (generic name: dupilumab) is approved to treat certain age groups with eczema (atopic dermatitis), asthma, chronic rhinosinusitis (sinus and nasal cavity swelling) with nasal polyps (tissue growths), chronic obstructive pulmonary disease (COPD), eosinophilic esophagitis, prurigo nodularis (a skin condition) and chronic spontaneous urticaria (a skin condition). Dupixent works blocking proteins (IL-4, IL-13) to help lower inflammation.

Dupixent is a steroid-free medicine given by subcutaneous (under the skin) injection. It is not considered an immunosuppressant.

What is the mechanism of action (MOA) for Dupixent?

Dupixent's mechanism of action (how it works) involves blocking 2 proteins in the body called interleukin-4 (IL-4) and interleukin-13 (IL-13) that can lead to inflammation. Inflammation can be associated with many medical conditions, including those Dupixent is approved to treat.

Blocking these interleukins can help lower the release of substances that may further worsen inflammation, like cytokines, chemokines, nitric oxide, and IgE.

• Cell types that express IL-4Rα (such as mast cells, eosinophils, macrophages, lymphocytes, epithelial cells, goblet cells) and inflammatory mediators (e.g., histamine, eicosanoids, leukotrienes, cytokines, chemokines) are involved in inflammation.
• Dupixent inhibits IL-4 and IL-13 signaling by specifically binding to the IL-4Rα subunit shared by the IL-4 and IL-13 receptor complexes. It inhibits IL-4 signaling via the Type I receptor and both IL-4 and IL-13 signaling through the Type II receptor.
• The exact mechanism of action of Dupixent has not been fully established.

Dupixent is classified as a human monoclonal IgG4 antibody and was first approved by the FDA in March 2017. It is manufactured by Regeneron.

Can Dupixent be used in children?

Yes, Dupixent can be used in children and adolescents for certain conditions and at certain ages.

Dupixent is approved for use in adults and children at least 6 months of age for treatment of moderate-to-severe eczema (atopic dermatitis) when other topical therapies (used on the skin) are not effective or advisable. For eczema, Dupixent can be used with or without topical corticosteroids.

Dupixent is also used as an add-on maintenance treatment in patients 6 years of age and older with moderate-to-severe asthma with high levels of white blood cells known as eosinophils (eosinophilic phenotype) or with oral corticosteroid-dependent asthma. Dupixent is NOT used to treat an asthma attack. For sudden breathing symptoms, you should use a rescue inhaler such as albuterol.

Dupixent is approved to treat eosinophilic esophagitis (EoE) in patients 1 years of age and older, weighing at least 15 kg (33 lb).

Dupixent is also used as an add-on maintenance treatment in patients 12 years of age and older with chronic rhinosinusitis (sinus and nasal cavity swelling) with nasal polyposis (nasal polyps which are growths on the sinuses).

In adults, Dupixent is also approved to treat prurigo nodularis, a skin condition characterized by hard and extremely itchy nodules that can worsen and spread.

It is also approved to treat adults with inadequately controlled chronic obstructive pulmonary disease (COPD) with an eosinophilic phenotype as an add-on maintenance treatment. Dupixent is NOT used to treat an asthma attack. For sudden breathing symptoms use a rescue inhaler such as albuterol.

Dupixent is also indicated for the treatment of adults and children aged 12 years and older with chronic spontaneous urticaria (CSU) who remain symptomatic despite H1 antihistamine treatment. It is not indicated for other types of urticaria. CSU is a skin condition characterized by hives or welts that are itchy and recur, tissue swelling (angioedema), or both, and that lasts more than 6 weeks.

Related questions

• What are the most common skin conditions? (with photos)
• Why do Dupixent injections hurt so much?
• How fast does Dupixent work?

How is Dupixent supplied?

Dupixent comes as a single-use pre-filled syringe (with a needle shield) or as a pre-filled pen. It is supplied in a carton with two pens or syringes in each package. It is given as a subcutaneous (under the skin) injection.

The pre-filled pen and pre-filled syringe contains either a 200 mg or 300 mg dose.

The Dupixent pre-filled pen is for use in patients 2 years of age and older. The prefilled syringe is for use in adults and children 6 months of age and older.

• In children 6 months to less than 12 years of age, Dupixent should be given by an adult caregiver.
• A caregiver or patient 12 years of age and older may inject Dupixent using the pre-filled syringe or pre-filled pen. In children 12 to 17 years of age, Dupixent should be administered under the supervision of an adult.

If your healthcare provider decides that you or a caregiver can give the injections, you or the caregiver should receive training on how to prepare and inject Dupixent before the first dose.

Directions on how to use the injections are also included with your Dupixent package. The manufacturer supplies videos on their website to demonstrate Dupixent injection. If you have questions, ask your doctor, nurse or pharmacist.

See the detailed "Instructions for Use" here. Always use Dupixent exactly as prescribed by your doctor.

Bottom Line

• Dupixent is approved for use in moderate-to-severe eczema (atopic dermatitis), in moderate-to-severe asthma, in patients with chronic rhinosinusitis (sinus and nasal cavity swelling) and nasal polyps (growths on the sinuses), in eosinophilic esophagitis (EoE), for prurigo nodularis (a skin condition), in chronic obstructive pulmonary disease (COPD) and in chronic spontaneous urticaria (a skin condition).
• Dupixent works blocking proteins called interleukins (IL-4, IL-13) to help lower inflammation. It blocks receptors in the body to help lower inflammation that can lead to symptoms in the approved conditions.
• Dupixent injection is given as a subcutaneous (under the skin) injection by syringe or pen. Patients can be taught to use it at home by self-injection or from an adult caregiver.

This is not all the information you need to know about Dupixent (dupilumab) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.