If you or someone you know has eosinophilic esophagitis, you may have heard about Dupixent. In 2022, Dupixent became the first medicine to be approved for treating eosinophilic esophagitis. Although other medicines are sometimes used to treat this condition, they work very differently than Dupixent.
Dupixent, which is injected into the body, works directly on the body’s immune system to help reduce symptoms of eosinophilic esophagitis.
How Does Dupixent Work for Eosinophilic Esophagitis?
Eosinophilic esophagitis is a long-term (chronic) condition that is caused by a type of white blood cell, called an eosinophil. In this condition, eosinophils gather in the lining of the esophagus, which is the tube that connects the mouth to the stomach. These cells can cause swelling (inflammation) that narrows the esophagus, making it difficult for food to move down into the stomach. This can cause issues with swallowing food. In some cases, food can even get stuck in the esophagus, which can cause vomiting and pain.
The key to treating this condition is to reduce the amount of swelling in the esophagus, which helps to reduce symptoms. In many cases, people with eosinophilic esophagitis have allergies to certain foods, which are called allergens. One way to manage this condition involves removing all allergens from the diet.
Some medicines that are taken by mouth can also improve symptoms of eosinophilic esophagitis. These include a group of medicines called proton pump inhibitors, such as lansoprazole (Prevacid), omeprazole (Prilosec), and pantoprazole (Protonix). These medicines reduce the amount of acid in the stomach, which can help to reduce swelling in the esophagus. Another group of medicines, called corticosteroids, can also help to reduce swelling.
The active ingredient in Dupixent is a medicine called dupilumab, which works by blocking certain proteins that send immune system signals in the body (interleukin-4 and interleukin-13). Blocking these proteins helps to reduce the swelling and irritation that happen in people with eosinophilic esophagitis.
How Was It Studied for Treating Eosinophilic Esophagitis?
Two clinical studies were done to see if Dupixent was safe and effective for the treatment of eosinophilic esophagitis. All people in these studies still had symptoms even after using a proton pump inhibitor for 2 months. One of these studies included people that were at least 12 years old, with an average age of 28 years. They lived in the U.S., Europe, Canada, and Australia, and most of them were male (67%). The other study included children that were 1-11 years old, with an average age of 7 years. Most of these children were White (82%) and most were male (76%).
In these studies, Dupixent was compared with a placebo. The people in the studies did not know whether they were receiving the drug or the placebo. Here is some other important information about the treatments used in these studies:
- People were told to continue using their proton pump inhibitor every day.
- Any other medicines used for eosinophilic esophagitis, such as corticosteroids, were stopped during the study.
- If anyone was already on a special diet to avoid allergens before the study, they were allowed to continue that diet during the study.
These studies measured efficacy by measuring the number of eosinophils in the lining of the esophagus. If the number of eosinophils falls below a certain level, then the condition is in “remission.” This means that there are not enough eosinophils left in the esophagus to cause symptoms.
The study in people who were 12 years and older also measured efficacy by asking everyone to rate their swallowing issues and related symptoms on a scale.
What Results Were Seen in These Clinical Studies?
Number of eosinophils in the esophagus. After 4-6 months of treatment, the studies looked at whether there were still enough eosinophils in the esophagus to cause symptoms. More people who used Dupixent (58%-68%) were in remission than people who used placebo (3%-6%).
Swallowing issues. In the study in people who were 12 years or older, after 6 months of treatment, people who used Dupixent had more improvement in their swallowing symptoms than people who used a placebo. The people that used Dupixent also had fewer days with swallowing issues each week, on average, than the people that used a placebo.
How Do I Use It?
Dupixent is a liquid that is injected under the skin every 1-2 weeks. Your health care provider will decide whether you should receive it every week or every 2 weeks, depending on your age and weight. It can be injected into the thigh, stomach, or outer area of the upper arm.
The drug comes in two forms. The most common form is a pre-filled device that is ready to be injected under the skin, so you do not need to learn how to use a syringe and needle. The other form is a pre-filled syringe with a needle, which is most often used in very young children. In either case, your health care provider will show you how to inject the drug before you use it the first time. Read the instructions for use, which you can get from your pharmacist.
It is important to inject the drug properly so that you get the right dose. Your prescription should come with “Instructions for Use,” which explains how to prepare and give a dose. Ask your pharmacist or other health care provider if you are unsure how to use Dupixent.
How Quickly Will Dupixent Work for Eosinophilic Esophagitis?
If Dupixent is working, you should have fewer swallowing issues within the first 1-2 months of using the medicine. Over the next few months, swallowing issues may continue to improve.
Do not stop using Dupixent or any other medicines for eosinophilic esophagitis without talking to your health care provider first, even if your symptoms have gotten better. Your symptoms may get worse again if you stop or change any of your medicines.
How Can I Prevent or Manage Side Effects?
The most common side effect seen with Dupixent is a skin reaction where you get the shot, which may involve redness, pain, swelling, and/or bruising. These reactions are most common after the first dose of Dupixent but can happen with later doses as well. The best way to decrease these reactions is to inject the drug into a different part of the body each time, which is called “rotating” the injection site. For example, Dupixent can be injected into different parts of the thigh, stomach, or outer area of the upper arms. Don’t inject the drug into skin that is already tender, damaged, bruised, or scarred.
People who use Dupixent for eosinophilic esophagitis may be more likely to have an infection of the airways. These include infections in the nose or throat, a sore throat, or common cold symptoms. The best way to prevent infection is to reduce your exposure to germs by washing your hands and avoiding people who are sick. You should also stay current on vaccinations, such as getting an annual flu vaccine.
These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. If you experience anything that you think may be caused by Dupixent, you can also report side effects to the FDA at 800-FDA-1088 (800-332-1088).
Are There Any Interactions With Other Medicines?
It is important for your health care provider to be aware of every medicine you are taking before you start using Dupixent, especially if you are taking any medicines for asthma.
Tell your pharmacist or other health care provider about all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken. This will help them find the best treatment plan for you.
Are There Any Interactions With Vaccines?
It is important to discuss any recent or upcoming vaccines (immunizations) with your health care provider. There are certain vaccines (“live” vaccines) that you should not receive either right before starting Dupixent or once you have already started using Dupixent. Your health care provider will confirm whether any recent or upcoming vaccines are safe.
Are There Any Special Steps Required to Get Dupixent?
Dupixent is a “specialty” medicine. This means that you can only get it from a specialty pharmacy, which may need to ship the medicine to you. This also means that it may require prior authorization from your insurance company. You can find out more about this at https://www.dupixent.com/support-savings/dupixent-my-way.
Is There a Coupon Card Available?
There is a savings coupon available from the drugmaker that may allow you to pay $0 for your prescription. Whether you are eligible depends on whether you have prescription insurance, and what type of insurance you have. You can find out more at https://www.dupixent.com/support-savings/copay-card.
For questions about cost, insurance coverage, or anything else, you can contact the drugmaker at 844-DUPIXENT (844-387-4936) or visit www.dupixent.com.
