Anti-IL-4/IL-13 receptor alpha monoclonal antibody (type 2 inflammation biologic) Pregnancy: Use only if benefit outweighs risk — limited human data; animal studies do not indicate harm.

Dupilumab (Moderate-Severe Asthma)

Brand names: Dupixent (200 mg/1.14 mL and 300 mg/2 mL prefilled syringe)

Adult dose

Dose: Type 2 asthma with eosinophilia or OCS-dependent: 400 mg loading SC (2×200 mg), then 200 mg SC every 2 weeks. OCS-dependent severe asthma: 600 mg loading (2×300 mg), then 300 mg every 2 weeks.

Route: Subcutaneous injection (thigh, abdomen, or upper arm)

Frequency: Every 2 weeks

Max: 300 mg every 2 weeks (OCS-dependent)

For moderate-severe type 2 asthma (raised eosinophils ≥150 cells/mcL or FeNO ≥25 ppb) uncontrolled on ICS/LABA. Unlike mepolizumab/benralizumab (IL-5 pathway), dupilumab blocks both IL-4 and IL-13 — relevant for eosinophilic and non-eosinophilic type 2 asthma. NICE TA751. Can concurrently treat atopic eczema.

Paediatric dose

Route: SC

Frequency: Every 2 weeks (≥30 kg) or every 4 weeks (<30 kg)

Max: 200 mg per dose

Concentration: 200 mg/1.14 mL mg/ml

Licensed ≥6 years for moderate-severe asthma. Children 6–11 years: weight-based dosing (15–<30 kg: 100 mg every 2 weeks; ≥30 kg: 200 mg every 2 weeks). Adolescents ≥12 years: adult regimen.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

No dose adjustment required.

Clinical pearls

LIBERTY ASTHMA QUEST trial: dupilumab reduces severe exacerbations by 48% and improves FEV₁ in moderate-severe asthma with type 2 biomarkers
Dual indication advantage: patients with both severe asthma and atopic eczema can treat both conditions with single biologic — unique vs IL-5 pathway biologics
Transient eosinophilia: blood eosinophils may rise in first few weeks — does not indicate treatment failure; usually resolves
Biomarker selection: most effective with blood eosinophils ≥150 cells/mcL or FeNO ≥25 ppb (type 2 inflammation markers)
NICE TA751 (2022): recommended for moderate-severe asthma with blood eosinophils ≥150 cells/mcL or FeNO ≥25 ppb, inadequately controlled on ICS/LABA ± OCS

Contraindications

Active helminth infection (IL-4/IL-13 involved in anti-helminth immunity — treat before starting)
Hypersensitivity to dupilumab

Side effects

Injection site reactions
Conjunctivitis (less common in asthma indication than eczema)
Nasopharyngitis
Headache
Eosinophilia (transient — monitor)

Interactions

Live attenuated vaccines — avoid during treatment
Other biologics — avoid combination

Monitoring

Blood eosinophil count (monitor for transient rise)
Exacerbation frequency — assess response at 16 weeks
FEV₁/peak flow
Conjunctivitis symptoms
OCS dose (steroid-sparing opportunity)

Reference: BNFc; BNF; NICE TA751 (2022); LIBERTY ASTHMA QUEST Trial (Castro et al, NEJM 2018). Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways