Mechanism of Action in CRSwNP | DUPIXENT® (dupilumab)

Type 2 inflammation plays an important role in CRSwNP—a chronic disease with a high symptom burden and substantial unmet need

Patients with inadequately controlled CRSwNP can experience the following^1-5:

Nasal obstruction
Nasal congestion
Difficulty breathing through the nose
Loss of smell

Social, emotional, and physical consequences
Increased need for sino-nasal surgery
Increased OCS use

Patients with CRSwNP often have comorbid diseases driven by Type 2 inflammation, which involves cytokines IL-4, IL-13, and IL-5^5-7

~50% asthma

14% NSAID-ERD

CRSwNP can remain uncontrolled in patients on standard-of-care therapies, which can lead to multiple sino-nasal surgeries and cycles of OCS use^4,5

NSAID-ERD, nonsteroidal anti-inflammatory drug-exacerbated respiratory disease; OCS, oral corticosteroid.

DUPIXENT is the first and only dual inhibitor of IL-4 and IL-13 signaling

DUPIXENT is a human monoclonal antibody that specifically binds to the IL-4Rα subunit shared by receptor complexes for IL-4 and IL-13⁸

DUPIXENT inhibits IL-4 signaling via the Type I receptor and both IL-4 and IL-13 signaling through the Type II receptor

DUPIXENT inhibits IL-4 and IL-13 cytokine-induced inflammatory responses that contribute to^8,9:

Eosinophil activation and trafficking
IgE release

Mast cell activation
Mucus hypersecretion

IMPORTANT SAFETY INFORMATION AND INDICATIONS

CONTRAINDICATION: DUPIXENT is contraindicated in patients with known hypersensitivity to dupilumab or any of its excipients.

WARNINGS AND PRECAUTIONS

Hypersensitivity: Hypersensitivity reactions, including generalized urticaria, rash, erythema nodosum, anaphylaxis and serum sickness or serum sickness-like reactions, were reported in <1% of subjects who received DUPIXENT in clinical trials. If a clinically significant hypersensitivity reaction occurs, institute appropriate therapy and discontinue DUPIXENT.

Conjunctivitis and Keratitis: Conjunctivitis occurred more frequently in chronic rhinosinusitis with nasal polyposis subjects who received DUPIXENT. There were no cases of keratitis reported in the CRSwNP development program. Among asthma subjects, the frequencies of conjunctivitis and keratitis were similar between DUPIXENT and placebo. Advise patients to report new onset or worsening eye symptoms to their healthcare provider.

Eosinophilic Conditions: Patients being treated for asthma may present with serious systemic eosinophilia sometimes presenting with clinical features of eosinophilic pneumonia or vasculitis consistent with eosinophilic granulomatosis with polyangiitis (EGPA), conditions which are often treated with systemic corticosteroid therapy. These events may be associated with the reduction of oral corticosteroid therapy. Physicians should be alert to vasculitic rash, worsening pulmonary symptoms, cardiac complications, and/or neuropathy presenting in their patients with eosinophilia. Cases of eosinophilic pneumonia were reported in adult patients who participated in the asthma development program and cases of vasculitis consistent with EGPA have been reported with DUPIXENT in adult patients who participated in the asthma development program as well as in adult patients with co-morbid asthma in the CRSwNP development program. A causal association between DUPIXENT and these conditions has not been established.

Acute Asthma Symptoms or Deteriorating Disease: Do not use DUPIXENT to treat acute asthma symptoms, acute exacerbations, acute bronchospasm or status asthmaticus. Patients should seek medical advice if their asthma remains uncontrolled or worsens after initiation of DUPIXENT.

Reduction of Corticosteroid Dosage: Do not discontinue systemic, topical, or inhaled corticosteroids abruptly upon initiation with DUPIXENT. Reductions in corticosteroid dose, if appropriate, should be gradual and performed under the direct supervision of a physician. Reduction in corticosteroid dose may be associated with systemic withdrawal symptoms and/or unmask conditions previously suppressed by systemic corticosteroid therapy.

Patients with Co-Morbid Asthma: Advise patients with co-morbid asthma not to adjust or stop their asthma treatments without consultation with their physician.

Parasitic (Helminth) Infections: It is unknown if DUPIXENT will influence the immune response against helminth infections. Treat patients with pre-existing helminth infections before initiating therapy with DUPIXENT. If patients become infected while receiving treatment with DUPIXENT and do not respond to anti-helminth treatment, discontinue treatment with DUPIXENT until the infection resolves.

ADVERSE REACTIONS:

Asthma: The most common adverse reactions (incidence ≥1%) are injection site reactions, oropharyngeal pain, and eosinophilia.
Chronic rhinosinusitis with nasal polyposis: The most common adverse reactions (incidence ≥1%) are injection site reactions, eosinophilia, insomnia, toothache, gastritis, arthralgia, and conjunctivitis.

DRUG INTERACTIONS: Avoid use of live vaccines in patients treated with DUPIXENT.

USE IN SPECIFIC POPULATIONS

Pregnancy: Available data from case reports and case series with DUPIXENT use in pregnant women have not identified a drug-associated risk of major birth defects, miscarriage or adverse maternal or fetal outcomes. Human IgG antibodies are known to cross the placental barrier; therefore, DUPIXENT may be transmitted from the mother to the developing fetus.
Lactation: There are no data on the presence of DUPIXENT in human milk, the effects on the breastfed infant, or the effects on milk production. Maternal IgG is known to be present in human milk. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for DUPIXENT and any potential adverse effects on the breastfed child from DUPIXENT or from the underlying maternal condition.

Please see accompanying full Prescribing Information.

Indications

Asthma: DUPIXENT is indicated as an add-on maintenance treatment in patients with moderate-to-severe asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid dependent asthma. Limitation of Use: DUPIXENT is not indicated for the relief of acute bronchospasm or status asthmaticus.

Chronic rhinosinusitis with nasal polyposis (CRSwNP): DUPIXENT is indicated as an add-on maintenance treatment in adult patients with inadequately controlled CRSwNP.

Unmet Need

Type 2 inflammation plays an important role in CRSwNP—a chronic disease with a high symptom burden and substantial unmet need

Patients with inadequately controlled CRSwNP can experience the following^1-5:

Patients with CRSwNP often have comorbid diseases driven by Type 2 inflammation, which involves cytokines IL-4, IL-13, and IL-5^5-7

CRSwNP can remain uncontrolled in patients on standard-of-care therapies, which can lead to multiple sino-nasal surgeries and cycles of OCS use^4,5