Dupilumab

Source is the UK SPC for Dupixent 200 mg solution for injection in pre-filled pen; the atopic dermatitis adult regimen is given as the primary dose above. Treatment should be initiated by healthcare professionals experienced in the diagnosis and treatment of the conditions for which dupilumab is indicated. OTHER ADULT INDICATIONS in the same §4.2: Asthma (adults and adolescents 12 years and older) — initial 400 mg (two 200 mg injections) then 200 mg every other week; for severe asthma on oral corticosteroids, severe asthma with co-morbid moderate-to-severe atopic dermatitis, or adults with co-morbid severe chronic rhinosinusitis with nasal polyposis — initial 600 mg (two 300 mg injections) then 300 mg every other week. Eosinophilic oesophagitis (adults, adolescents and children 1 year and older weighing at least 15 kg) — by weight band: 15 to <30 kg 200 mg every other week; 30 to <40 kg 300 mg every other week; 40 kg or more 300 mg every week. Chronic spontaneous urticaria (adults) — initial 600 mg (two 300 mg injections) then 300 mg every other week. DURATION/REVIEW: consider discontinuing in patients with no response after 16 weeks of treatment for atopic dermatitis (some partial responders improve beyond 16 weeks); dupilumab may be used with or without topical corticosteroids, and topical calcineurin inhibitors may be used but reserved for problem areas (face, neck, intertriginous, genital). For asthma it is intended for long-term treatment with the need for continued therapy reviewed at least annually; patients on concomitant oral corticosteroids may reduce the steroid dose gradually once clinical improvement occurs. MISSED DOSE: weekly dose missed — give as soon as possible and start a new schedule from that date; every-other-week or every-4-week dose missed — give within 7 days and resume the original schedule, otherwise (Q2W) wait for the next scheduled dose or (Q4W) give the dose and start a new schedule from that date. ELDERLY: no dose adjustment for patients 65 years and over. HEPATIC: no data in hepatic impairment. PAEDIATRIC (fixed weight-band doses, not per-kg, so paedDose is null): Atopic dermatitis — adolescents 12 to 17 years: <60 kg initial 400 mg (two 200 mg injections) then 200 mg every other week; 60 kg or more initial 600 mg (two 300 mg injections) then 300 mg every other week. Children 6 to 11 years: 15 kg to <60 kg 300 mg on Day 1 then 300 mg on Day 15, then 300 mg every 4 weeks starting 4 weeks after the Day 15 dose (may be increased to 200 mg every other week based on physician assessment); 60 kg or more initial 600 mg then 300 mg every other week. Children 6 months to 5 years: 5 kg to <15 kg 200 mg then 200 mg every 4 weeks; 15 kg to <30 kg 300 mg then 300 mg every 4 weeks. Asthma, children 6 to 11 years: 15 to <30 kg 300 mg every 4 weeks; 30 kg to <60 kg 200 mg every other week or 300 mg every 4 weeks; 60 kg or more 200 mg every other week. Chronic spontaneous urticaria, adolescents 12 to 17 years: 30 to <60 kg initial 400 mg then 200 mg every other week; 60 kg or more initial 600 mg then 300 mg every other week. Verify any under-18 use against a children's formulary. Note the eMC bundle did not include §4.5, so no interactions are listed here — check the SPC §4.5 before sign-off.