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Dupilumab

Medically reviewed on Nov 15, 2018

Pronunciation

See also: Dupixent

(doo PIL ue mab)

Index Terms

  • Dupixent

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution Prefilled Syringe, Subcutaneous [preservative free]:

Dupixent: 300 mg/2 mL (2 mL); 200 mg/1.14 mL (1.14 mL) [contains polysorbate 80]

Brand Names: U.S.

  • Dupixent

Pharmacologic Category

  • Interleukin-4 Receptor Antagonist
  • Monoclonal Antibody
  • Monoclonal Antibody, Anti-Asthmatic

Pharmacology

Dupilumab is a human monoclonal IgG4 antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling by binding to the IL-4Rα subunit. Blocking IL-4Rα with dupilumab inhibits IL-4 and IL-13 cytokine-induced inflammatory responses, including the release of proinflammatory cytokines, chemokines, nitric oxide and IgE; however, the mechanism of dupilumab action in asthma has not been definitively established.

Distribution

Vd: ~4.8 ± 1.3 L

Metabolism

Monoclonal antibodies are primarily degraded into small peptides and amino acids by catabolism

Excretion

Clearance: The median time to non-detectable concentrations is 10 weeks (for 300 mg every 2 weeks) and 13 weeks (for 300 mg weekly).

Time to Peak

~1 week

Special Populations Note

Weight: Dupilumab trough concentrations were lower in subjects with higher body weight.

Use: Labeled Indications

Asthma: Add-on maintenance treatment of moderate to severe asthma in adults and pediatric patients ≥12 years of age with an eosinophilic phenotype or with corticosteroid dependent asthma

Limitations of use: Not indicated for the relief of acute bronchospasm or status asthmaticus.

Atopic dermatitis: Treatment of moderate to severe atopic dermatitis in adults whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable.

Contraindications

Known hypersensitivity to dupilumab or any component of the formulation

Dosing: Adult

Asthma, moderate to severe: SubQ:

Initial: 400 mg (given as two 200 mg injections) or 600 mg (given as two 300 mg injections)

Maintenance: 200 mg (following 400 mg initial dose) or 300 mg (following 600 mg initial dose) once every other week

Asthma, oral corticosteroid dependent or with comorbid moderate to severe atopic dermatitis: SubQ:

Initial: 600 mg (given as two 300 mg injections)

Maintenance: 300 mg once every other week

Atopic dermatitis: SubQ:

Initial: 600 mg (given as two 300 mg injections)

Maintenance: 300 mg once every other week

Missed doses: If a dose is missed, administer within 7 days from the missed dose and then resume the original schedule. If the missed dose is not administered within 7 days, wait until the next dose on the original schedule.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Asthma, moderate to severe: Adolescents ≥12 years: SubQ: Refer to adult dosing.

Asthma, oral corticosteroid dependent or with comorbid moderate to severe atopic dermatitis: Adolescents ≥12 years: SubQ: Refer to adult dosing.

Dosing: Renal Impairment

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Dosing: Hepatic Impairment

There are no dosage adjustments provided in the manufacturer's labeling (has not been studied).

Administration

SubQ: Administer as a subcutaneous injection into the thigh or lower abdomen (avoiding areas within 2 inches of navel); caregiver may administer in upper arm. Rotate injection sites, including initial doses (administer 600 mg initial dose as two 300 mg injections; administer 400 mg initial dose as two 200 mg injections). Do not administer into skin that is tender, damaged, bruised, or scarred. Patients may self-administer injection after proper training. Allow solution to reach room temperature for 45 minutes (300 mg prefilled syringe) or 30 minutes (200 mg prefilled syringe) prior to use; do not remove needle cap while allowing product to reach room temperature. Do not shake. Do not use if solution is discolored or contains particulate matter. Prefilled syringe does not contain a preservative; discard unused portion.

Storage

Store at 2°C to 8°C (36°F to 46°F). Do not freeze. Do not expose to direct heat. Protect from light; do not expose to direct sunlight. Do not shake. Prefilled syringes may be stored up to 25°C (77°F) for a maximum of 14 days; after removal from refrigerator, use within 14 days or discard.

Drug Interactions

Belimumab: Monoclonal Antibodies may enhance the adverse/toxic effect of Belimumab. Avoid combination

Vaccines (Live): Dupilumab may enhance the adverse/toxic effect of Vaccines (Live). Avoid combination

Adverse Reactions

1% to 10%:

Dermatologic: Herpes simplex infection (2%)

Gastrointestinal: Oral herpes (4%)

Immunologic: Antibody development (7%; neutralizing: 2%)

Local: Injection site reaction (10%)

Ophthalmic: Conjunctivitis (10%), eye pruritus (1%)

<1%, postmarketing, and/or case reports: Eosinophilia (transient), hypersensitivity reaction, keratitis, serum sickness, serum sickness-like reaction, urticaria, xerophthalmia

Warnings/Precautions

Concerns related to adverse effects:

• Hypersensitivity: Hypersensitivity reactions, including urticaria, rash, erythema nodosum, and serum sickness or serum sickness-like reactions, have been reported (rare); if signs/symptoms of a serious hypersensitivity reaction develop discontinue immediately and initiate appropriate treatment.

• Eosinophilia and vasculitis: In rare cases, patients may present with serious systemic eosinophilia, sometimes presenting with clinical features of eosinophilic pneumonia or vasculitis consistent with eosinophilic granulomatosis with polyangiitis, a condition which is often treated with systemic corticosteroid therapy. Health care providers should be alert to eosinophilia, vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients. A causal association between dupilumab and these underlying conditions has not been established.

• Ocular effects: Conjunctivitis and keratitis have been reported; report new-onset or worsening eye symptoms to health care provider.

Disease-related concerns:

• Asthma: Discontinuation or adjustment of asthma medications in patients treated for atopic dermatitis with comorbid asthma should not be done without consulting health care provider.

• Helminth infections: It is unknown if administration of dupilumab will influence a patient's response against parasitic infections; patients with known helminth infections were not studied. Therefore, patients with preexisting helminth infections should undergo treatment of the infection prior to initiation of dupilumab therapy. Patients who become infected during treatment and do not respond to anti-helminth therapy should discontinue dupilumab until the infection resolves.

Concurrent drug therapy issues:

• Corticosteroid therapy: Gradually taper systemic, topical, or inhaled corticosteroid therapy; do not discontinue corticosteroids abruptly following initiation of dupilumab therapy.

• Drug-drug interactions: Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information.

Dosage form specific issues:

• Polysorbate 80: Some dosage forms may contain polysorbate 80 (also known as Tweens). Hypersensitivity reactions, usually a delayed reaction, have been reported following exposure to pharmaceutical products containing polysorbate 80 in certain individuals (Isaksson 2002; Lucente 2000; Shelley 1995). Thrombocytopenia, ascites, pulmonary deterioration, and renal and hepatic failure have been reported in premature neonates after receiving parenteral products containing polysorbate 80 (Alade 1986; CDC 1984). See manufacturer's labeling.

Other warnings/precautions:

• Appropriate use: Asthma: Therapy has not been shown to alleviate acute asthma exacerbations; do not use to treat acute bronchospasm or status asthmaticus.

• Appropriate use: Atopic dermatitis: Dupilumab may be used in combination with or without topical corticosteroids. Topical calcineurin inhibitors may be used, but should be reserved for problem areas only (eg, face, neck intertriginous and genital areas).

• Immunogenicity: Dupilumab antibodies, including neutralizing antibodies, may develop; may be associated with lower serum dupilumab concentrations.

• Vaccines: Avoid the use of live vaccines in patients treated with dupilumab.

Monitoring Parameters

Monitor for signs/symptoms of hypersensitivity reactions and ocular adverse effects; signs of infection; pulmonary function in patients treated for asthma

Pregnancy Considerations

Dupilumab is a monoclonal IgG antibody; IgG molecules are known to cross the placenta therefore exposure to the fetus during pregnancy may occur. Uncontrolled asthma is associated with adverse events on pregnancy (increased risk of preeclampsia, preterm birth, low birth weight infants). Asthma should be closely monitored in pregnant women.

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Patient may experience injection site irritation or cold sores. Have patient report immediately to prescriber vision changes, eye pain, swollen glands, joint pain, or severe eye irritation (HCAHPS).

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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