WHAT IS DUPIXENT (DUPILUMAB)?
Dupixent (dupilumab) is a medication for the treatment of severe atopic eczema. It is administered as a subcutaneous injection once every two weeks. Dupilumab is a man-made antibody. These types of medications are also called biologics. Biologics already existed for the treatment of psoriasis, but not yet for atopic eczema. Dupilumab was registered in the Netherlands in September 2017.
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HOW DOES DUPIXENT (DUPILUMAB) WORK?
In atopic eczema, the skin is constantly inflamed, manifested by redness and flaking. This inflammatory process is driven by proteins produced by the immune system, called interleukins. Interleukin 4 (IL-4) and interleukin 13 (IL-13) play a key role in atopic eczema. These interleukins exert their effect by binding to a protein on the surface of inflammatory cells. This protein is called a receptor. Dupixent (dupilumab) blocks the receptor for IL-4 and IL-13. This reduces inflammation. The drug has been studied in large numbers of patients; in this study, it was compared with a dummy drug (injection with a placebo). This study showed a significant improvement in eczema after just one week. The eczema patches decreased, the itching decreased, sleep improved and the patients felt that their quality of life had improved.
WHO IS ELIGIBLE FOR TREATMENT WITH DUPIXENT?Because Dupixent is an expensive medication, certain conditions apply to its prescription. The prescription must be for moderate to severe atopic eczema in adults and children aged 12 years or older, or severe atopic eczema in children aged 6 months to 11 years, that does not respond to standard treatments such as corticosteroids, Protopic or Elidel, or light therapy, nor to treatment with tablets such as prednisone, ciclosporin, methotrexate, Imuran (azathioprine), or Cellcept (mycophenolate mofetil). Or, these treatments cannot be administered due to side effects or other reasons. Dupixent is also used for chronic itching with persistent itchy bumps (prurigo nodularis).
HOW IS DUPIXENT GIVEN?Dupixent is administered as an injection under your skin (subcutaneous injection), in the abdomen or thigh. The injection can be administered by a doctor, nurse, or doctor's assistant, but after some explanation and instruction, you can also do it yourself. Most patients inject themselves. The Dupixent package insert clearly explains how to do this.
Each syringe contains one dose of Dupixent (300 mg). Do not shake the syringe. Read the instructions that come with the syringe carefully before using Dupixent.
The recommended initial dose is 600 mg (two 300 mg injections), followed by 300 mg every other week.
Do not stop taking Dupixent without first talking to your doctor.WHEN SHOULD YOU NOT USE THIS PRODUCT?Dupilumab should not be used if you are hypersensitive to the drug or any of the ingredients added to the solution: L-arginine hydrochloride, L-histidine, polysorbate 80, sodium acetate, acetic acid, and sucrose.
Symptoms of an allergic or hypersensitivity reaction to dupilumab may include fever, general malaise, swollen lymph nodes, hives (urticaria), itching, joint pain, and rash. Stop using Dupixent if you experience any of these symptoms, contact your doctor, and seek immediate medical attention if you experience a severe allergic reaction.
Parasitic infections (worm infections) of the intestines are also a problem. Dupixent lowers your resistance to infections caused by intestinal parasites. If you have a parasitic infection, it must be treated before starting treatment with Dupixent. Intestinal parasites can be contracted when visiting the tropics. If you have visited the tropics in the past five years and/or experienced symptoms such as diarrhea, flatulence, stomach upset, oily stools, or dehydration, you may have contracted a parasitic infection. It is advisable to have your stool tested for the presence of worms or worm eggs.WARNINGS AND PRECAUTIONSIf you also have asthma, your symptoms may improve while using Dupixent. However, don't change your asthma medication yourself; discuss it with the doctor who prescribed it. Be aware that if you stop taking Dupixent, your asthma may return with full severity.
One of the main side effects of Dupixent is irritation and inflammation of the mucous membranes of the eye (conjunctivitis). Contact your doctor if you experience eye problems. Eye drops can often resolve the problem. Sometimes a referral to an ophthalmologist is necessary.PREGNANCY AND BREASTFEEDINGShortly after the introduction of Dupixent, it was recommended to discontinue use during pregnancy and breastfeeding due to insufficient safety data. Several women have since used it during pregnancy and breastfeeding without any adverse effects on the child. Consult your doctor. It is usually advised to simply continue. It is recommended that the baby not be vaccinated with live attenuated vaccines within three months of the last exposure to dupilumab. However, in the Netherlands, such vaccines are not used in the first year of life, only at 14 months (MMR vaccine). Dupixent can pass into breast milk in very small quantities, but the baby cannot absorb it that way. The protein is too large to pass through the intestinal wall. Therefore, it must be administered by injection.SIDE EFFECTSLike all medicines, Dupixent can cause side effects. Possible side effects include:
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allergic reactions (hypersensitivity reactions); symptoms of an allergic reaction include fever, general illness, swollen lymph nodes, hives, itching, joint pain, rash |
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reactions at the injection site (redness, swelling and itching) |
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inflamed eyes (conjunctivitis), eye infection |
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dry eyes, redness and itching |
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eyelid itching, redness and swelling |
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headache |
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cold sores (on lips and skin) |
HOW TO STORE DUPIXENT (DUPILUMAB)?
Store Dupixent in the refrigerator (2-8°C). Remove it from the refrigerator 45 minutes before injecting so that it is cooler when injecting. Do not store outside the refrigerator at room temperature (<25°C) for longer than 2 weeks. Do not use if the expiry date has passed. Keep out of the sight and reach of children. Return any remaining contents to your pharmacy. |
