|Target||IL4 receptor alpha|
|Main uses||Eczema, asthma, nasal polyps|
|Side effects||Pain at site of injection, dry eyes, throat pain, trouble sleeping, red eyes|
|Chemical and physical data|
|Molar mass||146898.98 g·mol−1|
Dupilumab, sold under the brand name Dupixent, is a medication used for eczema (atopic dermatitis), asthma, or nasal polyps. It is used in eczema when topical corticosteroids have not been sufficient. It is given by injection under the skin.
Common side effects include pain at the site of injection, dry eyes, throat pain, trouble sleeping, and red eyes. Other side effects may include allergic reactions, cold sores, and inflammation of the cornea. Safety in pregnancy is unclear. It is a monoclonal antibody that blocks the target receptors of interleukin 4 (IL4) and interleukin 13 (IL13).
Dupilumab was approved for medical use in the United States and Europe in 2017. In the United Kingdom it costs the NHS about £1,300 every 4 weeks as of 2021. In the United States this amount costs about 3,400 USD.
Dupilumab appears to be useful for moderate-to-severe atopic dermatitis for which it is approved in the United States. It is also being evaluated for treatment of persistent asthma in adults and adolescents. Europe approved it in chronic rhinosinusitis with nasal polyposis (CRSwNP). It may also be used to treat eosinophilic esophagitis.
There is one reported case of dupilumab triggering hair growth in a patient with complete hair loss. This is being investigated as an unintended, but positive, side effect.
One other case reports a possibility of chronic eosinophilic pneumonia associated with dupilumab.
Some concern of potential worsened COVID-19 disease with patients taking dupilumab have been expressed, but according to one study all patients had mild course of disease.
Mechanism of action
Dupilumab binds to the alpha subunit of the interleukin-4 receptor (IL-4Rα), making it a receptor antagonist. Through blockade of IL-4Rα, dupilumab modulates signaling of both the interleukin 4 and interleukin 13 pathways. In clinical trials, specimens from people receiving dupilumab showed decreased levels of Th2 bio-markers.
Development of dupilumab was a joint effort by Regeneron Pharmaceuticals and Sanofi Genzyme, the latter of which provided 130 million dollars to Regeneron for research and development towards monoclonal antibodies.
The United States Food and Drug Administration granted it priority review status. On March 28, 2017, the U.S. Food and Drug Administration approved dupilumab injection to treat adults with moderate-to-severe eczema.
In October 2016, Regeneron completed a phase III trial comparing dupilumab with topical corticosteroids, in which subjects had a larger decrease in symptoms with both duplimab and topical steroids than with steroids alone.
Phase III studies were also performed to evaluate the efficacy of dupilumab in combination with topical corticosteroids. In these trials 38% and 36% of patients respectively, met the primary efficacy goal of the trial, compared to 8% and 10% under placebo.
Phase II trials for asthma treatment showed increased lung function for patients, showing increased forced expiratory volume.
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