Dupilumab
DUPIXENT
What it isIL-4 receptor-alpha antibody blocking IL-4 and IL-13 signaling; atopic dermatitis, asthma, nasal polyps, and COPD.
Why this oneIt treats a broad type-2 inflammatory spectrum without broad immunosuppression or routine laboratory monitoring.
What limits itConjunctivitis is characteristic; eosinophilia can complicate treatment, while cost and access are practical barriers.
FDA-approved for
- atopic dermatitis (2017)
- asthma, chronic rhinosinusitis with nasal polyps, COPD
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Atopic dermatitis | Adults | 600 mg (two 300 mg injections) | 300 mg Q2W | 300 mg Q2W |
| Atopic dermatitis | Pediatric 6 mo-17 yr | Weight-based (no load 6 mo-5 yr; 400-600 mg load 6-17 yr) | 200-300 mg Q2W or Q4W by weight | 300 mg Q2W |
| Asthma | Adults & peds ≥12 yr | 400 mg (or 600 mg) | 200 mg (or 300 mg) Q2W | 300 mg Q2W |
| Asthma | Pediatric 6-11 yr | Weight-based (no load) | 300 mg Q4W or 200 mg Q2W by weight | 200 mg Q2W |
| Chronic rhinosinusitis with nasal polyps | Adults & peds ≥12 yr | 300 mg Q2W | 300 mg Q2W | 300 mg Q2W |
| Eosinophilic esophagitis | Adults & peds ≥1 yr, ≥15 kg | 200-300 mg Q2W by weight | Up to 300 mg QW (≥40 kg) | 300 mg QW |
| Prurigo nodularis | Adults | 600 mg | 300 mg Q2W | 300 mg Q2W |
| Chronic obstructive pulmonary disease | Adults | 300 mg Q2W | 300 mg Q2W | 300 mg Q2W |
| Chronic spontaneous urticaria | Adults | 600 mg | 300 mg Q2W | 300 mg Q2W |
| Chronic spontaneous urticaria | Pediatric 2-17 yr | Weight-based (no load 2-5 yr; 400-600 mg load 6-17 yr) | 200-300 mg Q2W or Q4W by weight | 300 mg Q2W |
| Bullous pemphigoid | Adults | 600 mg | 300 mg Q2W with tapering oral corticosteroids | 300 mg Q2W |
| Allergic fungal rhinosinusitis | Adults | 300 mg Q2W | 300 mg Q2W | 300 mg Q2W |
Renal Undefined
Hepatic Undefined
Dosing varies by indication, age, and body weight
Instructions
- SC injection into thigh or abdomen (upper arm if caregiver); rotate sites
- For a 600 mg or 400 mg initial dose, give as two injections at different sites
- Consider completing age-appropriate vaccinations before starting; avoid live vaccines
Cautions
- Hypersensitivity (anaphylaxis, AGEP, serum sickness, angioedema)
- Conjunctivitis, keratitis, blepharitis
- Eosinophilic conditions/EGPA (especially with corticosteroid reduction)
- Do not treat acute asthma/COPD symptoms
- Do not abruptly reduce corticosteroids
- New-onset psoriasis
- Arthralgia and psoriatic arthritis
- Treat pre-existing helminth infections first
- Avoid live vaccines
Adverse reactions
- Injection site reactions
- Conjunctivitis
- Blepharitis
- Oral herpes
- Keratitis
- Eye pruritus
- Dry eye
- Eosinophilia
- Oropharyngeal pain
Pregnancy Available data have not identified drug-associated risk; IgG crosses the placenta.
Lactation No data; maternal IgG is present in human milk.
NO BOXED WARNINGS
Principal riskConjunctivitis, and eosinophilia
Cost, est. cash$200–$1,500/month
Generic entry2031 est. (biosimilar)
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
Mechanism of action: Dupilumab ballicule
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Memory aids: mascots and interaction avatars
