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Dupilumab (Dupixent) dose for asthma

Question:

Dupilumab (Dupixent) dose for asthma: when do you use 200 mg vs. 300 mg?

Answer:

By Ves Dimov, MD

Dupilumab (Dupixent) is indicated as an add-on maintenance treatment for moderate-to-severe asthma in patients aged 12 years and older with eosinophilic phenotype or PO corticosteroid dependent asthma.

Dupilumab (Dupixent) dose for asthma:
- 400 mg SC once, then 200 mg q2weeks, OR
- 600 mg SC once, then 300 mg q2weeks

For patients with PO corticosteroid-dependent asthma or comorbid moderate-to-severe atopic dermatitis (for which dupilumab is indicated), administer 600 mg initial dose then 300 mg q2weeks.

The answer is:
- 200 mg maintenance dose is for moderate-to-severe asthma with eosinophilic phenotype
- 300 mg maintenance dose is for PO corticosteroid-dependent asthma or comorbid moderate-to-severe atopic dermatitis

You could use 300 mg for moderate-to-severe asthma with eosinophilic phenotype, but the NEJM graph here shows that the doses response curves run parallel to each other and there is not benefit of the higher dose: https://www.nejm.org/doi/full/10.1056/NEJMoa1804092#figures_media

The Chief Scientific Officer of Regeneron regards these as 2 separate groups: "Dupixent is now approved in the U.S. for two important groups of uncontrolled asthma patients – those who are moderate-to-severe with an eosinophilic phenotype or those with oral corticosteroid-dependent asthma".

Dupixent is expected to be approved for chronic sinusitis at the 300 mg dose. (https://www.ncbi.nlm.nih.gov/pubmed/26836729)

References:
https://reference.medscape.com/drug/dupixent-dupilumab-1000131
https://www.nejm.org/doi/full/10.1056/NEJMoa1804092
https://www.nejm.org/doi/full/10.1056/NEJMoa1804093
https://newsroom.regeneron.com/news-releases/news-release-details/fda-approves-asthma-indication-dupixentr-dupilumab
https://www.annallergy.org/article/S1081-1206(18)30156-X/abstract