Dupilimab

Question 1

What is the PBS criteria for starting someone on dupilimab (for AD)?

Answer 1

12 years or old
Must be treated by a Derm / Immuno
Must have had skin lesions > 6 months

Whole body criteria:
- despite medium to high potency topical steroids for 28 days has:
* PGA score >4
* EASI score >20
* Recorded DLQI score

Face and / or hands:
- despite medium to high potency TCI or calcinurin inhibitors has:
* Eczema Area and Severity Index (EASI) symptom sub-scores for erythema, oedema/papulation, excoriation, lichenification rated as severe
* at least 30% of the face/hands surface area affected
* Recorded DLQI score

Question 2

What is the PBS criteria for continuing someone on dupilimab (for AD)?

Answer 2

The patient must have acheived or maintained an adequate response** within the first 16 weeks of treatment;**

For WHOLE BODY adequate response to treatment is defined as

(a) An improvement/maintenance in the Eczema Area and Severity Index (EASI) score of at least 50% compared to baseline; and

(b) An improvement/maintenance in Dermatology Life Quality Index (DLQI) score of at least 4 points compared to baseline

For HANDS / FACE an adequate response to treatment of the face/hands is defined as:

(a) (i) A rating of either mild (1) to none (0) on at least 3 of the assessments of erythema, oedema/papulation, excoriation and lichenification mentioned in the Eczema Area and Severity Index (EASI); or

(ii) At least a 75% reduction in the skin area affected by this condition compared to baseline; and

(b) An improvement in Dermatology Life Quality Index (DLQI) score of at least 4 points compared to baseline

Question 3

What is Dupilumab?

Answer 3

A monoclonal antibody against IL-4 and IL -13.

It targets the IL-4 receptor alpha subunit

Question 4

Describe to a paitent how Dupilimab is injected?

Answer 4

Subcutaneous injection - injection under the surface of the skin into the fat

The first dose is a loading dose (meaning a higher dose = 2 injections), following by a single injection every 2 weeks.

Dose for adults:
* 600mg loading
* 300mg fortnightly

Children 6 - 17 years
* > 60kgs = adult dose
* 30 - 60 kgs = 400mg loading, 200mg fortnightly
* 15 - 30kgs = 600mg loading, 300mg every 4 weeks

Children 6 months to 5 years
* No loading dose
* 15 - 30kgs = 300mg every 4 weeks
* <15kgs = 200mg every 4 weeks

Question 5

What are the contraindications (including relative) to dupilimab?

Answer 5

Known hypersensitivity

Relative:
* Known Helminth infection (strongyloides)
* Severe ocular disease (needs clearance by opthal first)

Question 6

What are the main side effects ass with dupixent?

Answer 6

Ocular:
* Conjunctivitis (10%)
* Keratitis
* dry eyes, blepharitis, keratitis, eyelid dermatitis, and palpebral
edema

Injection site reactions (10%)
* Pain, erythema, bruising

Facial and neck dermatitis
* potential contributing factors including rosacea/demodicosis, allergic
contact dermatitis, and Malassezia-related dermatitis

Psoriasis

Haematologic
* Transient increase in eosinophils

Question 7

Is dupixent safe in pregnancy? and lactation?

Answer 7

Limited data

Discussion with patient.

If benefits outwiegh risks to the patient - then ok to continue.

Question 8

How can you treat / prevent ocular side effects?

Answer 8

Preservative free lubricant eye drops

Warm compress
Antihistamine/mast cell stabilizer eye drops

corticosteroid, cyclosporine, or lifitegrast eye drops and tacrolimus ointment represent additional treatment options - best guided by an opthalmologist

Question 10

Can you give someone a live vaccine on Dupilimab?

Answer 10

Best avoided