What is dupilumab?
Dupilumab is a new biologic treatment for eczema that was licensed for adults in 2018 and 12-17-year-olds in 2019 in the UK. Other biologic treatments in development are: tralokinumab and lebrikizumab (blocks IL-13). Biologic agents have been used to treat other inflammatory skin conditions, such as psoriasis, for many years, and have provided a useful addition to therapeutic options for management.
Dupilumab is a type of medicine known as a monoclonal antibody that is given as a subcutaneous injection (i.e. just below the skin). It is supplied as a ready-to-use syringe and needle, which either the person using it or their carer can administer, provided they have received training from a doctor or nurse.
How does dupilumab work?
Dupilumab is targeted at one aspect of the immune system that is involved in the skin inflammation in people with eczema. It works by attaching to a molecule called the IL-4 receptor subunit which sits primarily on the surface of cells of the immune system. This interferes with the messages of two molecules, IL-4 and IL-13 , which trigger inflammation of the skin. Dupilumab and other biologic drugs normalise the body’s immune system and are not general immunosuppressants.
Dupilumab blocks the actions of IL-4 and IL-13. Using the analogy that a chemical messenger, such as IL-4, binds to a receptor – like a key fitting into a lock – a biologic therapy is like fixing a coin over a keyhole so that the key (IL-4) cannot get into the lock.
Research has shown that in the majority of people who receive it, dupilumab produces a significant reduction in the severity of eczema as well as a reduction in the amount of body surface affected. People receiving dupilumab have also experienced a reduction in itching and an improvement in sleep and quality of life. Some of these people had not responded to any of the current systemic immunosuppressants available.
When is dupilumab used?
Dupilumab is licensed for adults and children aged 12-17 with moderate to severe eczema who are possible candidates for systemic therapy. It is unlikely that anyone whose eczema is not at the severe end of the spectrum will be considered for dupilumab. To be eligible, you will need to have tried at least one immunosuppressive drug and the drug needs to have not worked effectively for you. You may also be eligible for dupilumab if you have been found to be ineligible for immunosuppressive drugs, e.g. if it is known that your body will not tolerate them. Dupilumab is significantly more expensive than other drugs currently available for eczema, which might make it more difficult to access. It is not currently available for children under the age of 12 outside of a clinical trial.
Dupilumab is given by injection under the skin once every two weeks. A single syringe and needle delivers one dose.
No drug-specific blood test monitoring is required while taking dupilumab.
This is an ongoing treatment rather than a treatment that is used for a fixed amount of time. People would be expected to show a significant reduction in eczema symptoms and an improvement in quality of life after having taken dupilumab for 16 weeks. If the eczema has not responded adequately to dupilumab after 16 weeks, the treatment may be stopped.
Who should NOT use dupilumab?
It is best to avoid taking dupilumab while breastfeeding. As this is a new treatment, there is currently only limited research data on the use of dupilumab by pregnant women. Dupilumab should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. It is important to speak to your dermatologist about your specific situation.
What are the side effects of dupilumab?
During clinical trials, cold sores and eye inflammation occurred more commonly in people receiving dupilumab compared with a placebo. People who have asthma as well as eczema could experience a worsening of their asthma symptoms if they stop taking dupilumab.
The action of dupilumab is a very specific block of the inflammation pathways and it could be predicted that a monoclonal antibody (made by identical immune cells) blocking IL-4 and IL-13 would have fewer potential adverse effects than a conventional immunosuppressive drug (i.e. azathioprine, ciclosporin, methotrexate, mycophenolate mofetil). Although there were few adverse effects seen in the dupilumab trials, as with all new drugs where long-term use is envisaged, it is important to establish whether there are any long-term effects.
For more information on dupilumab, please see our Dupilumab factsheet