Dupilumab: An Injectable Medication for Moderate to Severe Eczema

There may be a good solution to your endless itching and skin patches

Dupilumab Can Treat the Skin and Itch of Moderate to Severe Eczema
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Atopic dermatitis, also known as eczema, is a common, chronic skin disease that causes dry, itchy, flaky, and sometimes crusting or oozing red skin. It often begins in childhood and for some people can persist through adulthood. In fact, according to the American Academy of Dermatology, approximately one to three percent of adults worldwide have atopic dermatitis.

The precise cause of atopic dermatitis is still being debated and studied, but likely entails a complex interplay between a person's genes, their immune system, and an impaired function of the epidermis—the outermost layer of a person's skin.

Atopic dermatitis can usually be managed with:

  • Good skin care, including moisturization.
  • Removal of triggers and aggravating factors.
  • Treatments applied on the skin, like prescription steroid creams and ointments.

However, in some adults with moderate to severe eczema, their disease doesn't improve with traditional therapies (or they are unable to take these therapies), so a genetically engineered injectable may be needed.

Dupixent (dupilumab) is the first and only injectable medication FDA approved for treating moderate to severe eczema in adults. It is injected every two weeks into the thigh or lower abdomen within the fatty layer just below the skin—this is called a subcutaneous injection.

The good news is that your doctor or nurse can teach you or a loved one how to give the injection, so you can do it from the comfort of your home. It's also good to note that dupilumab can be used in combination with topical steroid therapies, or it can be used by itself.

How Dupilumub Works

Dupilumab is a biologic medication, which means that it works on the whole body to change the way your immune system works. It is a human monoclonal antibody—a type of antibody created in a laboratory.

Once injected and absorbed into the bloodstream, dupilumab binds to a specific docking site that ultimately blocks the action of two messenger proteins (interleukin-4 and interleukin-13).

These proteins are known to play a major role in the formation of eczema patches.

Effects of Dupilumab

Research has revealed not only a reduction in the body surface area and severity of eczema patches but also a significant reduction in itching, which can be extremely debilitating for people with atopic dermatitis. In addition, in two 16-week phase three trials, dupilumab was found to reduce symptoms of anxiety and depression and improve quality of life.

Are There Any Adverse Effects to Note?

Dupilumab may cause skin irritation at the site of injection. Although rare, it can also cause a serious allergic reaction, as well as eye problems like dry eye, eye itching, pink eye (called conjunctivitis), eyelid inflammation (called blepharitis), or inflammation of the cornea (called keratitis). Sores on or around the lips and throughout the mouth (called oral herpes) have also been reported.

It's important to contact your doctor right away if you experience vision problems, eye pain, or severe eye irritation. It's also important to stop dupilumab and seek medical attention if you experience symptoms of an allergic reaction like hives, skin rash with or without a fever, swollen lymph nodes, joint pain, itching, or a general ill feeling.

Of course, what is mentioned above is not all the potential side effects a person may experience with dupilumab, so be sure to contact your doctor with any problems or worries.

Finally, some people develop antibodies to dupilumab, which occurs when the body produces a protein to neutralize or inhibit the drug's biological effect. This may be suspected if a person stops responding to dupilumab and can be confirmed with a blood test.

What Should I Tell My Doctor Before I Start Dupilumab?

Before you take dupilumab, tell your doctor all of your health conditions, especially if you have eye problems, a parasitic infection, or asthma.

Also, be sure to tell your doctor whether you are pregnant, breastfeeding, or scheduled to receive any vaccinations. Due to the effects on a person's immune system, it is advised that no one taking dupilumab receive any live vaccinations (for example, the intranasal flu or zoster vaccine).

It's also important to share with your doctor all your medications, including any over-the-counter drugs, vitamins, or supplements.

The big picture here is to be prepared when visiting your allergist. By being thorough and sharing all your medical history with your doctor, she can determine if dupilumab is the right treatment for you.

A Word From Verywell

Severe atopic dermatitis can cause extensive eczema patches on the body, which can be both physically and mentally draining. Dupilumab provides an option for those adults who have moderate to severe disease but have not received the relief they deserve with conventional therapies like steroid creams and ointments. In addition, dupilumab appears to be safe, although the increased risk for eye problems needs to be teased out more.

That being said, this medication is not for everyone, and at this time, it's really reserved for those who have no other options. Stay on board as research continues to evolve on injectable biologics for eczema.

Sources:

American Academy of Dermatology. Atopic Dermatitis: Who Gets And Causes.

Beck LA et al. Dupilumab treatment in adults with moderate-to-severe atopic dermatitis. N Engl J Med. 2014 Jul 10;371(2):130-9.

Simpson EL et al. Two phase 3 trials of Dupilumab versus placebo in atopic dermatitis. N Engl J Med. 2016 Dec 15;375(24):2335-2348.

Spergel JM. (February 2015). Management of severe refractory atopic dermatitis (eczema). In: UpToDate, Dellavalle RP (Ed), UpToDate, Waltham, MA.

U.S. Food and Drug Administration. (March 2017). Full Prescribing Contents: Dupixent.

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