IL-4Rα Inhibitor (Anti-IL-4/IL-13) Pregnancy: Use with caution — IgG4 antibody crosses placenta; limited data; use only if clearly needed

Dupilumab (CRSwNP)

Brand names: Dupixent

Adult dose

Dose: 300 mg SC every 2 weeks

Route: Subcutaneous injection

Frequency: Every 2 weeks

Max: 300 mg per dose

Chronic rhinosinusitis with nasal polyps (CRSwNP) — add-on to intranasal steroids; also licensed for atopic dermatitis and severe asthma; single autoinjector pen

Paediatric dose

Dose: Not established for CRSwNP in paediatrics N/A/kg

Route: N/A

Frequency: N/A

Max: N/A

CRSwNP indication adults only; AD and asthma licensed from age 6

Dose adjustments

Renal

No dose adjustment required

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Patient weight (kg)

CRSwNP indication adults only; AD and asthma licensed from age 6

Clinical pearls

SINUS-24 and SINUS-52 trials (Bachert et al. NEJM 2019): dupilumab significantly reduced nasal polyp score, nasal congestion, and need for systemic corticosteroids or surgery vs placebo — NICE TA654 approved
CRSwNP pathophysiology: type 2 inflammation driven by IL-4 and IL-13 causes polyp formation, mucosal oedema, and anosmia — dupilumab's dual IL-4/IL-13 blockade addresses the root cytokine driver, explaining its efficacy across all atopic conditions
Anosmia improvement: dupilumab significantly restores sense of smell in CRSwNP — patient-reported outcome improved in >70% of responders; anosmia is often the most distressing symptom for patients and a key quality-of-life marker
Conjunctivitis risk: higher incidence in CRSwNP than dermatitis — use lubricating eye drops prophylactically; refer to ophthalmology if persistent; rarely leads to discontinuation
Assessment at 16 weeks: if no clinically meaningful response (polyp size reduction, symptom improvement), consider discontinuation; NICE TA654 requires response assessment before continued prescription

Contraindications

Known hypersensitivity to dupilumab
Active helminth infection (treat before starting)

Side effects

Injection site reactions
Conjunctivitis/blepharitis (common — up to 10%)
Nasopharyngitis
Eosinophilia (transient)
Arthralgia

Interactions

Live vaccines — avoid
Adjust dose of CYP450 substrates (ciclosporin, warfarin) — IL-4/13 inhibition normalises elevated CYP450 levels in atopic disease

Monitoring

Nasal polyp score (endoscopy)
SNOT-22 (symptom score)
Conjunctivitis symptoms
Eosinophil count
Anosmia assessment (smell test)

Reference: BNFc; BNF 90; SINUS-24 & SINUS-52 trials (Bachert et al. NEJM 2019); NICE TA654; MHRA SPC Dupixent; EPOS 2020 European Position Paper on Rhinosinusitis. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways