• Dupilumab is a monoclonal antibody which was approved by US FDA in March 2017 to use as a subcutaneous injection for treating moderate-to-severe atopic dermatitis.
Dupilumab is prescribed for the treatment of moderate-to-severe atopic dermatitis (a skin disorder in which the skin is dry and itchy with red and scaly rashes) in adult patients who do not respond to topical therapies or who cannot tolerate the medicines that are normally used to treat it.
Dupilumab is an interleukin 4-receptor alpha antagonist. It interferes with the signaling of the inflammatory mediators interleukin-4 and interleukin-13, thereby reducing the inflammation in the body.
Dupilumab is used along with topical corticosteroids or alone as a monotherapy.
Dupilumab should not be used in patients-
• Hypersensitivity or allergy to dupilumab
• Children younger than 18 years of age
• Existing eye disorders
• Known parasite infections
• The recommended adult dose of dupilumab is 600mg (2 injections of 300mg each administered at two different sites of the body) as an initial dose which is followed by 300mg subcutaneously administered every other week.
• If a dose is missed, patients are advised to take the missed dose if it is within 1 week and then follow the prescribed schedule.
• If the dose is missed for more than 1 week then the patients should skip the missed dose and take the next dose at the specified time schedule.
• Dupilumab comes as a pre-filled syringe which has to be injected under the skin as a subcutaneous injection.
• Before injecting dupilumab, it is necessary to allow the medication to come to room temperature by keeping outside for around 45 minutes. It is not advised to heat it by keeping in the microwave oven or placing in hot liquids.
• It is important to check the medication for the presence of any visible particles or cloudy appearance. If present, the injection must be discarded.
• The injection sites are thighs or abdomen except at the navel and the area around 2 inches or 5 cm around the navel. Do not inject into the skin where the area is tender, red or bruised, or hard either with scars or stretch marks.
• Patients should be advised to report to the emergency center if any allergic reactions such as urticaria or serum sickness occur. In such cases, the treatment should be discontinued and the subjects should be treated appropriately.
• Patients with asthma should not stop or adjust the treatment schedule of asthma while on dupilumab without consulting the treating physician.
• Eye disorders such as conjunctivitis and keratitis frequently occur and patients should be intimated to report about the new onset or worsening of the eye disorders.
• Parasitic infections should be treated prior starting dupilumab therapy.
• Caution is advised in pregnancy and breastfeeding since adequate safety information is not available in these conditions.
• Common: Pain or swelling at the injection site, puffy eyelids or redness of the eye, fever
• Gastrointestinal: Oral herpes
• Eye: Inflammation of the eyelid, cornea and/or conjunctiva, itching of the eye dryness of the eye, blurred vision
• Others: Other herpes simplex viral infections, allergic reactions, skin rashes, joint pain
• The prefilled syringe should be used only once by injecting all the solution and the used syringe should be disposed off safely.
• Do not shake the prefilled syringe and also care should be taken that not to be frozen.
• The prefilled syringe can be kept at a cool room temperature for about 2 weeks but should not be replaced back into the refrigerator. If it kept more than 2 weeks at a cool room temperature, the injection should be discarded.
• Taking a live vaccine such as measles-mumps-rubella (MMR), chicken pox or influenza vaccine is not advised during the treatment with dupilumab.
• Drugs of a narrow therapeutic index such as warfarin or cyclosporine should be cautiously used along with dupilumab by closely monitoring of the drug concentration or adverse effects so that the dose can be modified.
• Prescription or over-the-counter drugs or herbal supplements should be taken along with dupilumab only after the approval of the physician to avoid serious drug interactions.
• Store dupilumab injection in a refrigerator at 2°C to 8°C in the original carton and must be protected from light.
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