Dupilumab in Eosinophilic Asthma

Dupilumab is a fully human IgG4 monoclonal antibody targeting the alpha subunit of the IL-4 receptor (IL-4Rα), which is a shared component of both Type I (IL-4) and Type II (IL-4 + IL-13) receptor complexes. By binding IL-4Rα, dupilumab simultaneously blocks IL-4 and IL-13 signaling, the dominant Th2 cytokines driving eosinophilic airway inflammation, IgE class switch, mucus hypersecretion, smooth muscle hyperreactivity and airway remodeling.

It is approved for severe uncontrolled asthma with type 2 inflammation (blood eosinophils ≥ 150 cells/µL or FeNO ≥ 25 ppb), oral corticosteroid–dependent asthma irrespective of biomarker level, atopic dermatitis ≥ 6 months, eosinophilic esophagitis ≥ 1 year and ≥ 15 kg, chronic rhinosinusitis with nasal polyps in adults, and prurigo nodularis. In LIBERTY ASTHMA QUEST and VENTURE trials, dupilumab reduced annual severe exacerbation rate by 46–48%, improved pre-bronchodilator FEV1 by 130–340 mL, decreased OCS dose by ~70%, and over 50% of patients eliminated maintenance OCS.

Dosing in asthma: adults / adolescents ≥ 12 years initial 400 or 600 mg SC loading, then 200 or 300 mg every 2 weeks; pediatric 6–11 years dosed by weight (15–30 kg = 100 mg q2w; ≥ 30 kg = 200 mg q2w). It is administered as a subcutaneous prefilled syringe / pen, can be self-administered after training. Common adverse events: injection-site reactions, conjunctivitis (mostly mild), eosinophilia (transient peripheral rise), oropharyngeal pain. Rare: serum sickness, joint pain, eosinophilic granulomatosis with polyangiitis (EGPA) unmasking after OCS taper.