Dupilumab

How it works

It binds the shared alpha subunit of the interleukin-4 receptor, blocking signalling of both IL-4 and IL-13, the key cytokines driving type 2 inflammation.

Prescribing in practice

• Conjunctivitis and keratitis are recognised class effects; advise patients to report new or worsening eye symptoms and refer for ophthalmology assessment if severe or persistent.
• It is given by subcutaneous injection and, in atopic dermatitis, is typically reserved for disease inadequately controlled by topical therapy or where systemic treatment is indicated.
• Avoid initiating in the presence of active infection and ensure age-appropriate vaccinations are up to date before starting; live vaccines should generally be avoided during treatment.

Monitoring

Routine laboratory monitoring is not generally mandated, but patients should be reviewed for treatment response, injection-site and hypersensitivity reactions, and ocular symptoms.

Counselling the patient

• Report any new or worsening eye redness, irritation or visual change promptly.
• Patients or carers can be trained to self-administer the subcutaneous injection at home.
• Continue prescribed emollients and topical treatments alongside dupilumab unless told otherwise.

Evidence & guidelines

NICE has issued technology appraisal guidance supporting dupilumab for moderate-to-severe atopic dermatitis, supported by the pivotal SOLO and CHRONOS randomised trials.