Dupixent alternatives: What can I take instead of Dupixent for atopic dermatitis?

Compare Dupixent alternatives | Adbry | Cibinqo | Eucrisa | Opzelura | Rinvoq | Natural alternatives | How to switch meds

Eczema is a condition of inflamed skin that causes symptoms such as itching, dry skin, rashes, scaly patches, blisters, and skin infections. There are several different types of eczema. Atopic dermatitis (AD) is the most common type of eczema. 

AD is caused by an overactive immune system, which causes the skin to become very dry and itchy. AD affects many—over 9 million children and 16 million adults in the US have AD. About one-third of children and 40% of adults have moderate to severe AD, which can have a big impact on quality of life.  

Dupixent is a prescription drug used to treat atopic dermatitis. It is approved by the U.S. Food and Drug Administration (FDA). Dupixent can be used to treat adults and children 6 years and older with moderate to severe AD. Dupixent is administered by injection under the skin (subcutaneous injection). It is generally used when topical therapies (creams, ointments, etc) are not effective or cannot be tolerated. Dupixent can be used in combination with topical corticosteroids.

Besides AD, Dupixent has other indications for use. Dupixent can treat moderate to severe asthma. For this indication, Dupixent is used in combination with other medications and can treat adults and children ages 6 years and older who have moderate to severe eosinophilic asthma or asthma that requires oral steroids. Dupixent does not treat acute exacerbations of asthma. 

Another indication for Dupixent use is adults with chronic rhinosinusitis (inflammation of the sinus and nasal cavities) with nasal polyps. Dupixent can be used with other medications, when the condition is not adequately controlled.

Dupixent is available as a subcutaneous (SQ) injection, which means that it is injected under the skin. For atopic dermatitis, after an initial dose of 600 mg SQ, Dupixent is then given as a 300 mg dose every two weeks. Dupixent is a brand-name medication made by Sanofi-Aventis. There is no generic available for Dupixent at this time. 

Dupixent contains the ingredient dupilumab. Dupixent is a biologic and is part of a drug class called interleukin-4 receptor alpha antagonists. It is also known as a monoclonal antibody. Dupixent works by stopping the action of substances in the body that cause symptoms of AD. 

In some cases, patients may be looking for an alternative treatment to Dupixent. Some people may not have the desired effect and want to try a different medication to see if it works better. Others may have side effects that persist or are bothersome. Common side effects of Dupixent (when used for atopic dermatitis) as seen in clinical trials are:

• Injection site reaction (redness, pain, itching, swelling, inflammation)
• Oral herpes (cold sores)
• Conjunctivitis (pinkeye)
• Blepharitis (eyelid inflammation—symptoms include red, itchy, dry eyes )
• Keratitis (corneal inflammation, which requires prompt medical care—symptoms include eye redness, pain, and vision disturbances)
• Itchy, dry eyes

RELATED: Dupixent eye side effects

Or, a serious side effect could occur, such as a severe or life-threatening allergic reaction, severe joint pain, or serum sickness. 

In some cases, the price of Dupixent may be too high due to insurance copays. Whatever the reason, there are alternatives to Dupixent that you can discuss with your healthcare provider. 

Although Dupixent can be used for several different indications, this article will focus on Dupixent alternatives for atopic dermatitis.

What can I take in place of Dupixent?

There are other options available to treat AD that has not improved with Dupixent, or when Dupixent cannot be used. These alternative prescription medications are listed in the table below. These options may be more suitable for certain individuals due to their different drug class or side effect profiles. 

RELATED: Nucala vs. Dupixent

Other drugs that may be used in combination with Dupixent

The following drugs may be prescribed in combination with Dupixent. Dupixent is generally used when these types of medications have not been effective on their own, or cannot be tolerated. 

• Topical steroids, of varying potency, are usually used as a first-line treatment of atopic dermatitis. Dupixent or its alternatives are generally used when other treatments, such as topical steroids, have failed. Examples of topical steroids include hydrocortisone cream, Temovate (clobetasol), Kenalog (triamcinolone), and Lidex (fluocinonide).
• Oral steroids, such as prednisone, may be used to treat various inflammatory conditions such as AD.
• Oral antihistamines, such as Atarax (hydroxyzine) or Claritin (loratadine), are sometimes used to control symptoms of itching or hives associated with AD.

Top 5 Dupixent alternatives

The following are some of the most common alternatives to Dupixent.

1. Adbry (tralokinumab-ldrm) injection

Adbry is an interleukin-13 antagonist used to treat moderate to severe AD in adults who are not adequately controlled with topical medications or who cannot tolerate these medications. Adbry can be used with or without topical steroids. Adbry is made by LEO Pharma. Like Dupixent, Adbry is given by subcutaneous injection every two weeks. Common side effects of Adbry are upper respiratory infection, pinkeye, and injection site reactions. Before starting Adbry, all vaccinations must be up to date. Live vaccines (such as the measles, mumps, and rubella vaccine) cannot be used while the patient is taking Adbry. 

RELATED: Important information about Dupixent and vaccines

2. Cibinqo (abrocitinib) oral tablet

Cibinqo is a tablet that is taken by mouth every day. Cibinqo is classified in a group of drugs called Janus kinase (JAK) inhibitors. Cibinqo can be used to treat adults with moderate to severe AD when their symptoms are not adequately controlled with other medications, or when they cannot take or tolerate other medications. Cibinqo cannot be used in combination with other JAK inhibitors, biologic immunomodulators, or other immunosuppressants (such as cyclosporine). Cibinqo is made by Pfizer. Common side effects include headache, dizziness, nausea, vomiting, acne, herpes simplex infection, common cold, and urinary tract infection. 

Cibinqo has a boxed warning, which is the strongest warning required by the FDA. The warnings state that Cibinqo can cause an increased risk of:

• Serious infections that can lead to hospitalization or death
• Lymphoma and other cancers
• Higher rate of death, including sudden cardiovascular (heart) death
• Major cardiovascular events such as heart attack and stroke
• Thrombosis (blood clots) that may include deep vein thrombosis and pulmonary embolism

Some of these are more likely to occur in patients who are being treated for rheumatoid arthritis. However, anyone considering Cibinqo should discuss the risks versus benefits with their healthcare provider, who can provide appropriate medical advice.

3. Eucrisa (crisaborole) ointment

Eucrisa is a topical ointment that can be used to treat mild to moderate AD in adults and children 3 months and older. Eucrisa, made by Pfizer, is part of the phosphodiesterase 4 inhibitor drug class. Common side effects include pain, burning, and stinging at the application site.

4. Opzelura (ruxolitinib) cream

Opzelura is a topical cream that is used as a short-term treatment of mild to moderate AD in adults and adolescents 12 years and older who are not immunocompromised, and when symptoms are not adequately controlled by topical treatments. Opzelura is made by Incyte Corporation.

Common side effects of Opzelura are common cold, ear infection, bronchitis, diarrhea, hives, runny nose, tonsillitis, and inflamed hair follicles.

Like Cibinqo, Opzelura is a JAK inhibitor and has the same boxed warnings. Opzelura cannot be used in combination with other JAK inhibitors, biologic immunomodulators, or other immunosuppressants. 

5. Rinvoq (upadacitinib) extended-release tablet

Rinvoq is an extended-release tablet that is taken by mouth every day. It is a JAK inhibitor and can be used to treat adults and adolescents 12 years and older with moderate to severe AD when symptoms are not controlled with other medications, or other medications cannot be taken or tolerated. 

Rinvoq can also be used to treat rheumatoid arthritis, psoriatic arthritis (a type of arthritis that affects some people with psoriasis), and ulcerative colitis. 

Rinvoq is made by the company AbbVie. Common side effects of Rinvoq, when used for AD, are upper respiratory infection, herpes simplex infection, acne, headache, cough, allergic reactions, inflamed hair follicles, weight gain, fatigue, and muscle pain.

Like Cibinqo and Opzelura, Rinvoq cannot be used in combination with other JAK inhibitors, biologic immunomodulators, or other immunosuppressants. Rinvoq also has the same boxed warnings as Cibinqo and Opzelura. 

Natural alternatives to Dupixent

Atopic dermatitis can be treated as a comprehensive approach. Although prescription medication is an important part of the treatment plan, there are other parts of a treatment plan that may help symptoms, too. 

In terms of dietary changes, according to the National Eczema Association, “the reality is that, aside from avoiding foods that one is truly allergic to, of course, diets seem to have less effect in the real world than they seem to on the internet.” They do go on to say that although there is no evidence that restricting the diet will help avoid flares, that certain foods do cause inflammation in some people, and in these cases, avoiding gluten and dairy may help.

Some patients look to the vitamin aisle to help with AD. The National Eczema Association notes that severe eczema may be related to low vitamin D levels, so taking vitamin D may help eczema. 

Showers should be brief in length (under 10 minutes) and lukewarm, and a gentle cleanser should be used. Moisturizing after the shower is key. Coconut oil and sunflower seed oil moisturizers may be helpful to those with eczema. Some people also find success with acupuncture or hypnosis. 

However, while some of these measures discussed above may help, they are not a substitute for medication, but rather a complement to the medication. Consult your healthcare provider about natural and nonmedicinal methods you can try, in combination with your medications. Always consult your healthcare professional for medical advice before trying an herbal supplement, as some may have dangerous adverse effects or drug interactions with the medications you take.

How to switch to a Dupixent alternative

If you are interested in switching to a Dupixent alternative, you can take the following steps:

• If price is a concern, contact your insurance provider. Ask which Dupixent alternatives are covered on your formulary, and what the copay would be for each medication. Also, ask if your deductible has been met, or if you are still paying towards your deductible. 
• Reach out to your healthcare provider. Your provider may consult with you on the phone, or they may want you to make an appointment to discuss any changes. Either way, you can review your medical conditions and history, and discuss alternative medications—as well as potential side effects and drug interactions—with your provider. If your provider decides to prescribe a Dupixent alternative, they can send (or call in) the prescription to your preferred pharmacy. For Dupixent, this is usually a specialty pharmacy.
• Search the SingleCare website for free coupons. SingleCare customers save up to 80% on prescription prices, and the coupons can be applied to refills, too.