dupilumab
Brand: Dupixent
Prototype Drug
Drug Class: biologic — anti-IL-4/IL-13 monoclonal antibody
Drug Family: biologic
Subclass: IL-4Ralpha antagonist
Organ Systems: respiratoryimmunologydermatology
Mechanism of Action
Human monoclonal antibody blocking IL-4Ralpha, the shared receptor component for IL-4 and IL-13; reduces Th2-driven eosinophilic inflammation critical in asthma, atopic dermatitis, and nasal polyps.
IL-4 receptor alpha subunit (blocks IL-4 and IL-13 signaling)
Indications
- moderate-severe eosinophilic asthma or OCS-dependent asthma
- atopic dermatitis (moderate-severe)
- chronic rhinosinusitis with nasal polyps
- eosinophilic esophagitis
- prurigo nodularis
Contraindications
- hypersensitivity to dupilumab
- active parasitic (helminth) infection
Adverse Effects
Common
- injection site reactions
- conjunctivitis (unique to atopic dermatitis indication)
- headache
- arthralgia
Serious
- anaphylaxis (rare)
- helminth infection reactivation
Pharmacokinetics (ADME)
| Absorption | ~64% SC bioavailability |
| Distribution | serum and tissues |
| Metabolism | proteolytic degradation |
| Excretion | proteolysis |
| Half-life | ~25 days |
| Onset | 7 days |
| Peak | 1 week |
| Duration | 2 weeks |
| Protein Binding | <0% |
| Vd | 4.8 L |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| live vaccines | avoid during therapy | major |
| immunosuppressants | additive immunosuppression | moderate |
Nursing Considerations
- Assess for helminth infection before initiation
- Conjunctivitis is common in atopic dermatitis indication — ophthalmic consultation if persistent
- Initial dose then biweekly maintenance injections
- Clinical response at 12-16 weeks
- Continue controller medications (does not replace ICS)
Clinical Pearls
- First biologic approved for multiple Th2 eosinophilic conditions (asthma, AD, nasal polyps, EoE)
- Conjunctivitis occurs in 5-40% of AD patients — unique mechanism unknown
- LIBERTY ASTHMA QUEST: reduces exacerbations and OCS dependence in moderate-severe eosinophilic asthma
Safety Profile
Pregnancy insufficient-data
Lactation avoid
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Guideline Update pending
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.