Most people with atopic dermatitis (a type of eczema) are able to control their symptoms by using topical treatments that are applied to the skin. But for some people with severe atopic dermatitis, symptoms do not respond to these treatments. In recent years, new medicines have been approved that work in a different way to manage symptoms of atopic dermatitis. These medicines, which are injected into the body, work directly on the body’s immune system to reduce symptoms.
One of these injected medicines that may treat symptoms in certain people with severe atopic dermatitis is called Dupixent.
How Does Dupixent Work for Atopic Dermatitis?
Atopic dermatitis is a long-term (chronic) condition of the skin caused by an overactive immune system. The overactive immune system weakens the skin barrier, causing the skin to become inflamed, swollen, irritated, and dry. This causes itchiness and a rash that can appear on many parts of the body. The most common parts are the face, hands, feet, wrists, and the backs of the knees. The rash can be very different for different people and may be red, dry, cracked, swollen, or bumpy. In some people, it also oozes and crusts over.
People with atopic dermatitis sometimes have “flare-ups,” or times when their symptoms are most noticeable. These flare-ups can last days or even weeks. In some cases, atopic dermatitis may get worse when the skin dries out. This can be due to cold or dry air, or from taking multiple baths or showers without moisturizing the skin afterward.
Many different triggers can also make atopic dermatitis worse or cause a flare-up. For people who have allergies, exposure to an allergen (such as certain pollens, molds, animals, or foods) can trigger a flare-up. An infection, such as a cold or flu, can also be a trigger. Certain substances can act as a trigger when they touch the skin, such as:
- Fragrances or dyes found in skin care products
- Irritating chemicals
- Rough materials (such as wool)
For most people, the key to treating atopic dermatitis is to avoid triggers, moisturize the skin, and apply topical treatments as prescribed. But this does not always work for people with severe symptoms. People with severe atopic dermatitis may need additional treatments that target the body’s overactive immune system.
The active ingredient in Dupixent is a medicine called dupilumab, which works by blocking certain proteins that send immune system signals in the body (interleukin-4 and interleukin-13). Blocking these proteins helps to reduce the swelling and irritation from severe atopic dermatitis.
How Was It Studied for Treating Atopic Dermatitis?
Multiple clinical trials were done to see if Dupixent was safe and effective for the treatment of atopic dermatitis. All people in these studies had moderate to severe atopic dermatitis that still caused difficult symptoms even when using topical treatments. Here is some important information about the people in these studies.
- Adults. Two of these studies included adults who were 18 or older. The average age in these studies was 35-40. Most of the people were White (68%) and a little more than half were male (58%).
- Teenagers. One study included teenagers who were 12-17 years old, with an average age of 14. Most were White (63%) and a little more than half were male (59%).
- Children. One study included children who were 6 to 11 years old, with an average age of 8. Most of the children were White (69%). Half of them were male and half were female.
All of these studies measured efficacy by having a doctor rate a person’s rash before and during the study. Two different scales were used to rate the rash. One scale runs from 0-4, with 0 meaning that the rash is gone and 4 meaning that the rash is very severe. The other scale uses different information about the rash to track changes in its size and severity over time.
Dupixent was compared with placebo in every study. The people in the studies did not know whether they were receiving the drug or the placebo. Here is some other important information about the treatments used in these studies.
- Everyone was required to apply moisturizer two times every day.
- If people were using any medicines for atopic dermatitis before the study, these medicines were stopped during the study.
- Adults and teenagers did not use any other medicines during the study. But if a person had difficult symptoms during the study, they were allowed to use a “rescue medicine” to help with these symptoms.
- In the study with children, everyone used a medicine called a topical corticosteroid once every day during the study. If a child had difficult symptoms during the study, they were also allowed to use a “rescue medicine” to help with these symptoms.
What Benefits Were Seen in These Clinical Studies?
Rash severity. After 4 months of treatment, people who used Dupixent were more likely to have improvements in their rash than the people who used placebo. This was true for all scales used to rate the rash in adults, teenagers, and children.
- Adults
- On the scale that rated the rash from 0-4, more people who used Dupixent had a big drop in their score, down to 0-1. A score of 0-1 means that there was either no rash or the rash was almost gone. About 36%-38% of people using Dupixent had a big drop in their score, down to 0-1, compared to about 10% of people using placebo.
- On the scale that measured the size and severity of the rash, 44%-52% of people using Dupixent had their score improve by at least 75%. Only 12%-15% of people using placebo had their score improve by this much.
- Teenagers
- On the scale that rated the rash from 0-4, more people who used Dupixent had a score of 0-1 (no rash or the rash was almost gone). About 18%-24% of people using Dupixent had a score of 0-1 compared to about 10% of people using placebo.
- On the scale that measured the size and severity of the rash, about 38%-42% of people using Dupixent had their score improve by at least 75%. Only 8% of people using placebo had their score improve by this much.
- Children
- On the scale that rated the rash from 0-4, more people who used Dupixent had a score of 0-1 (no rash or the rash was almost gone). About 30%-33% of people using Dupixent had a score of 0-1 compared to about 11% of people using placebo.
- On the scale that measured the size and severity of the rash, about 67%-70% of people using Dupixent had their score improve by at least 75%. About 27% of people using placebo had their score improve by this much.
How Do I Use It?
Dupixent is a liquid that is injected under the skin every 2-4 weeks. Your health care provider will decide whether you should receive it every 2 weeks or every 4 weeks, depending on your age and weight. It can be injected into the thigh, stomach, or outer area of the upper arm.
The drug comes in two different forms. The most common form is a prefilled device that is ready to be injected under the skin, so you do not need to learn how to use a syringe and needle. The other form is a prefilled syringe with a needle, which is most often used in very young children. In either case, your health care provider will show you how to inject the drug before you use it the first time. Read the instructions for use, which you can get from your pharmacist.
It is important to inject the drug properly so that you get the right dose. Your prescription should come with “Instructions for Use,” which explains how to prepare and give a dose. Ask your pharmacist or other health care provider if you are unsure how to use Dupixent.
How Quickly Will Dupixent Work for Atopic Dermatitis?
If Dupixent is working, you should have fewer symptoms within the first few months of using the medicine. Over time, this should mean that the rash will take up less space on the body and will not be as severe.
Do not stop using Dupixent or any other medicines for atopic dermatitis without talking to your health care provider first, even if your rash has gotten better. Your rash and symptoms may get worse again if you stop or change any of your medicines.
How Can I Prevent or Manage Side Effects?
The most common side effect seen with Dupixent is a skin reaction at the injection site, which may involve redness, pain, swelling, and/or bruising. These reactions are most common after the first dose of Dupixent but can happen with later doses as well. The best way to decrease these reactions is to inject the drug into a different part of the body each time, which is called rotating the injection site. For example, Dupixent can be injected into different parts of the thigh, stomach, or outer area of the upper arms. Don’t inject the drug into skin that is already tender, damaged, bruised, or scarred.
Some people using Dupixent may develop conjunctivitis, which is swelling (inflammation) of the thin layer of tissue that covers the eye. This can cause the eye and eyelid to become itchy, red, and irritated. The best way to limit the risk for this side effect is to keep the eyes clean and to avoid rubbing the eye whenever possible.
These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. If you experience anything that you think may be caused by Dupixent, you can also report side effects to the FDA at 800-FDA-1088.
Are There Any Interactions With Other Medicines?
It is important for your health care provider to be aware of every medicine you are taking before you start using Dupixent, especially if you are taking any medicines for asthma.
Tell your pharmacist or health care provider about all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken. This will help them determine the best treatment plan for you.
Are There Any Interactions With Vaccines?
It is important to discuss any recent or upcoming vaccines (immunizations) with your health care provider. There are certain vaccines (“live” vaccines) that you should not receive either right before starting Dupixent or once you have already started using Dupixent. Your health care provider will confirm whether any recent or upcoming vaccines are safe.
Are There Any Special Steps Required to Get Dupixent?
Dupixent is a type of medicine called a “specialty” medicine. This means that you can only get it from a specialty pharmacy, which may need to ship the medicine to you. This also means that it may require prior authorization from your insurance company. You can find out more about this at https://www.dupixent.com/support-savings/dupixent-my-way.
Is There a Coupon Card Available?
There is a savings coupon available from the manufacturer that may allow you to pay $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance and what type of insurance you have. You can find out more at https://www.dupixent.com/support-savings/copay-card.
