STEPS

New Drug Reviews

Dupilumab (Dupixent) for Asthma

 

Am Fam Physician. 2020 Feb 15;101(4):244-245.

Dupilumab (Dupixent) is a monoclonal antibody injection labeled for the treatment of moderate to severe asthma in patients 12 years and older with an eosinophilic phenotype or who require oral corticosteroid treatment. It was previously labeled for the treatment of atopic dermatitis and chronic rhinosinusitis with nasal polyposis.

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DrugDosageDose formCost*

Dupilumab (Dupixent)

400 mg or 600 mg for initial dose, then 200 mg or 300 mg every two weeks

200-mg/1.14-mL or 300-mg/2-mL single-use prefilled injector pen

$3,160 for two injector pens


*—Estimated retail price for one month of treatment based on information obtained at https://www.drugs.com (accessed December 17, 2019).

DrugDosageDose formCost*

Dupilumab (Dupixent)

400 mg or 600 mg for initial dose, then 200 mg or 300 mg every two weeks

200-mg/1.14-mL or 300-mg/2-mL single-use prefilled injector pen

$3,160 for two injector pens


*—Estimated retail price for one month of treatment based on information obtained at https://www.drugs.com (accessed December 17, 2019).

Safety

Hypersensitivity reactions occur in less than 1% of patients. Dupilumab carries a risk of eosinophilia, which may lead to serious conditions such as eosinophilic pneumonia or vasculitis. In clinical trials, 1% to 2% of participants developed eosinophilia.1 Although there have been isolated reports of eosinophilic pneumonia, there has been no significant increase in the incidence of severe eosinophilic conditions such as pneumonia, vasculitis, or granulomatosis, though studies are limited. Dupilumab has not been studied in women who are pregnant or lactating. Patients should not receive live vaccines while being treated with dupilumab.1

Tolerability

Dupilumab is generally well tolerated. The most common adverse effects are injection site reaction (10% to 14%), conjunctivitis (2% to 10%), oral herpes virus infection (4%), arthralgias (3%), and gastritis (2%). The rate of treatment discontinuation because of adverse effects was low in all available studies. Only 3% of participants discontinued treatment at the 200-mg dose compared with 6% of those taking the 300-mg dose and 4% in the placebo group.1

Effectiveness

In patients with moderate to severe asthma, one year of dupilumab therapy decreases the rate of severe asthma exacerbations (i.e., a worsening respiratory status requiring treatment for three or more

Author disclosure: No relevant financial affiliations.

Address correspondence to Kathleen Barry, MD, at Kathleen.Barry@umassmemorial.org. Reprints are not available from the authors.

References

1. DailyMed. Drug label information: Dupixent—dupilumab injection, solution. Accessed June 11, 2019. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=595f437d-2729-40bb-9c62-c8ece1f82780

2. Castro M, Corren J, Pavord ID, et al. Dupilumab efficacy and safety in moderate-to-severe uncontrolled asthma. N Engl J Med. 2018;378(26):2486–2496.

3. Rabe KF, Nair P, Brusselle G, et al. Efficacy and safety of dupilumab in glucocorticoid-dependent severe asthma. N Engl J Med. 2018;378(26):2475–2485.

STEPS new drug reviews cover Safety, Tolerability, Effectiveness, Price, and Simplicity. Each independent review is provided by authors who have no financial association with the drug manufacturer.

This series is coordinated by Allen F. Shaughnessy, PharmD, MMedEd, assistant medical editor.

A collection of STEPS published in AFP is available at https://www.aafp.org/afp/steps.

 

 

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