Biologic (IL-4 / IL-13 receptor antagonist) Pregnancy: Use only if benefit outweighs risk. Limited data in pregnancy.

Dupilumab

Brand names: Dupixent

Adult dose

Dose: Atopic dermatitis: 300 mg SC every 2 weeks (after 600 mg loading); Asthma: 200–300 mg SC every 2 weeks

Route: Subcutaneous injection

Frequency: Every 2 weeks

Max: 300 mg every 2 weeks

Atopic eczema: 600 mg loading (2×300 mg), then 300 mg every 2 weeks. Severe asthma (Type 2): 200 mg or 300 mg every 2 weeks depending on phenotype. Inject into thigh, abdomen, or upper arm. Can be self-administered. Refrigerate (allow to warm before injection).

Paediatric dose

Route: SC

Frequency: Every 4 weeks (<30 kg) or every 2 weeks (≥30 kg)

Max: 300 mg per dose

6 months–5 years: 200 mg every 4 weeks (<15 kg); 300 mg every 4 weeks (15–<30 kg). 6–11 years: 300 mg every 4 weeks (<30 kg); 200 mg every 2 weeks (≥30 kg). ≥12 years: adult dosing.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required.

Clinical pearls

First biologic specifically targeting Th2 inflammation — transforms treatment of severe atopic eczema
Conjunctivitis: occurs in 5–28% — proactive eye drops (hypromellose), ophthalmology referral if persistent
NICE TA534: Dupilumab for severe atopic eczema not controlled by systemic therapies
Can be used in combination with moderate topical corticosteroids
Treat parasitic infections before starting (live parasites depend on IL-4/IL-13 immunity)

Contraindications

Hypersensitivity to dupilumab
Active helminthic (parasite) infection (IL-4/IL-13 involved in anti-helminth immunity)

Side effects

Injection site reactions
Conjunctivitis (common — significant in eczema patients)
Keratitis and blepharitis
Nasopharyngitis
Headache
Eosinophilia (transient)

Interactions

Live attenuated vaccines — avoid during treatment
Other biologics — increased immunosuppression risk

Monitoring

EASI/IGA score (response assessment at 16 weeks)
Conjunctivitis symptoms
Injection site reactions

Reference: BNFc; BNF; NICE TA534; BAD Dupilumab Guidelines; EADV Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways