Introduction

Dupilumab (trade name: Dupixent) has been approved in Germany since September 2017 for the treatment of moderate to severe eczema in adults who are able to have treatment with tablets or injections (systemic treatment). As of August 2019, it is also approved for use in children aged 12 years and over under the same conditions.

Eczema – also known as atopic eczema or atopic dermatitis – is a chronic (long-lasting), non-infectious skin condition.

Typical symptoms include rashes and severe itching that come and go in episodes. The acute symptoms include red and itchy skin, sometimes with blisters that easily break and then weep (leak liquid). Over time the skin can become dry and cracked, and also thicken.

Eczema mainly affects the hollows of your knees, elbows and the back of your neck. The itchy rash may also occur on your palms and the soles of your feet. It rarely affects the face. Eczema is usually treated with creams or ointments. If the symptoms are bad, UV light or what's known as systemic treatment can also be used.

Treatment with dupilumab aims to decrease the inflammation in the skin by inhibiting a chemical messenger that causes inflammation.

Application

Dupilumab is available as pre-filled syringes at doses of 200 or 300 mg.

  • Adults and teenagers with a body weight over 60 kg: The first time dupilumab is used, 600 mg of the medication is injected under the skin (two injections of 300 mg each). After that, one 300 mg injection is used every two weeks.
  • Teenagers with a body weight of less than 60 kg: At first, 400 mg of the medication is injected under the skin (two injections of 200 mg each). After that, one 200 mg injection is used every two weeks.

Patients can also inject themselves after being instructed how to do so by a doctor.

The effectiveness of the treatment needs to be assessed regularly. If there is no improvement after 16 weeks, doctors usually recommend stopping the treatment.

Other treatments

For people with moderate to severe eczema who are able to have systemic treatment, the standard approach is optimized individual treatment. This treatment will depend on various factors, including which treatments have been tried before. It is individually adjusted by the doctor. The medication options include tacrolimus, glucocorticoids (steroids used on the skin as a cream) and ciclosporin. In adults, UV light treatment or the systemic use of glucocorticoids are also options.

Assessment

In 2018, the Institute for Quality and Efficiency in Health Care (IQWiG, Germany) looked into whether dupilumab has any advantages or disadvantages compared to optimized individual treatment in adults with moderate to severe eczema.

In 2019, IQWiG looked into whether dupilumab has any advantages or disadvantages compared to optimized individual treatment for moderate to severe eczema in children aged 12 years and over.

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More information

This information summarizes the main results of reviews produced by the Institute for Quality and Efficiency in Health Care (IQWiG, Germany). The reviews were commissioned by the German Federal Joint Committee (G-BA) as part of the “early benefit assessment of medications.”

On the basis of the reviews and the hearings received, the G-BA passed a resolution on the added benefit of dupilumab (Dupixent) for teenagers and adults.

Labels: Dupilumab, Dupixent, L20