Dupilumab
Biologics for asthma
Biologics for asthma
An antibody against the IL-4 receptor that blocks IL-4 and IL-13; used for atopic dermatitis, asthma, nasal polyps and other type 2 diseases.
Quick facts
- Group
- Biologics for asthma
- Target
- Interleukin-4 receptor alpha chain (IL-4Rα)
- Used for
- Moderate to severe atopic dermatitis
- Key effects
- Injection-site reactions · Conjunctivitis · Cold sores
- Monitor
- Eye symptoms at every visit
- ATC
- D11AH05
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows the Fab fragment of dupilumab bound to the human IL-4 receptor alpha chain.
Dupilumab is a fully human monoclonal antibody that binds IL-4 receptor alpha, the chain shared by the type I receptor (for IL-4) and the type II receptor (for IL-4 and IL-13). Blocking both cytokines reduces IgE production, mucus, airway hyperresponsiveness, skin barrier damage and itch. Because eosinophils are kept out of tissues, blood eosinophil counts can rise temporarily.
- Dupilumab binds IL-4 receptor alpha
- Both IL-4 and IL-13 lose their signal
- IgE, mucus and skin inflammation fall
- Asthma flare-ups and eczema improve
Indications
- Moderate to severe atopic dermatitis Atopic dermatitis →
- Moderate to severe asthma with a type 2 or eosinophilic phenotype, or steroid-dependent Asthma →
- Chronic rhinosinusitis with nasal polyps Chronic rhinosinusitis and nasal polyps →
- Eosinophilic esophagitis Eosinophilic oesophagitis →
- COPD with raised blood eosinophils Chronic obstructive pulmonary disease (COPD) →
Adverse effects
Common
- Injection-site reactions
- Conjunctivitis and other eye inflammation
- Cold sores (oral herpes)
- Joint pain; transient rise in blood eosinophils
Contraindications
- Hypersensitivity to dupilumab
- Not for acute bronchospasm
- Existing helminth infection is treated first
Key interactions
- Live vaccines
- Avoided during treatment; vaccinations are reviewed before starting
- Oral and inhaled corticosteroids
- Not stopped abruptly; reduction is gradual
What is monitored
- Eye symptoms at every visit
- Asthma control and skin disease scores
- Blood eosinophils if symptoms of eosinophilic disease appear
Administration and safety
- Subcutaneous injection by prefilled syringe or pen, at home after training
- The device is brought to room temperature before injection and not shaken
- Injection sites are rotated
Pregnancy and breastfeeding
Antibodies cross the placenta, especially late in pregnancy; pregnancy data are limited and use is decided with the specialist.
Nursing care
- Teach to report red, painful eyes or vision change
- Review vaccinations before starting, and avoid live vaccines during treatment
- Teach injection technique and site rotation
Pharmacokinetics
- Absorption
- Subcutaneous injection, slowly absorbed
- Elimination
- Target-mediated and by proteolysis like other antibodies
- Onset and duration
- Improvement over weeks
Test yourself
Think of the answer, then tap the question to see it.
How does dupilumab block both IL-4 and IL-13?
It binds IL-4 receptor alpha, the chain shared by both cytokines' receptors.
Which eye side effect is typical of dupilumab?
Conjunctivitis (and other eye inflammation).
Which three diseases does dupilumab treat?
Atopic dermatitis, asthma and chronic rhinosinusitis with nasal polyps (also eosinophilic esophagitis, COPD).
Connections
← Back to the class: Biologics for asthma
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Dupilumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
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Representative model, for educational purposes only.