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A pregnant person looking at their belly: Can you take Dupixent while pregnant?
Drug Info

Can you take Dupixent while pregnant?

There’s a lack of definitive research to determine whether Dupixent is safe during pregnancy
Leandra Beabout
By | Sep. 15, 2024 Medically reviewed by Jesse P. Houghton, MD, FACG

Key takeaways

  • There is not enough research to confirm whether Dupixent (dupilumab) during pregnancy is safe.

  • The use of Dupixent by a pregnant person should be a shared decision between a patient and healthcare provider. Together, they should weigh the potential risks of fetal exposure and the benefits of treatment.

  • There are pregnancy-safe alternatives to Dupixent, but they might not be as effective at treating atopic eczema, prurigo nodularis, or asthma.

In this article:

Dupixent (dupilumab) is an injectable medication used to treat moderate-to-severe atopic dermatitis (AD), also known as eczema, in adults and children 6 years and older. It is also approved by the Food and Drug Administration (FDA) for several other uses, including:

  • As an add-on maintenance treatment for severe asthma in adults and children 6 years and older 
  • As an add-on maintenance treatment for chronic rhinosinusitis with nasal polyps in adults
  • As a treatment for prurigo nodularis in adults
  • As a treatment for eosinophilic esophagitis (EoE) in adults and children 1 year and older

Ultimately, this biologic drug acts as an immune system modulator, dampening the inflammatory symptoms of autoimmune conditions. 

The National Eczema Association reports that AD is more common in adult females than males. With that knowledge, you might wonder: Is Dupixent safe during pregnancy? We’ll cover what you need to know if you’re considering taking Dupixent while pregnant and why it’s so important to consult your healthcare provider about whether the risks outweigh the benefits.

Can you take Dupixent while pregnant?

The short answer is: Maybe. Some healthcare providers prescribe Dupixent to pregnant women if the benefits outweigh the potential risks. However, “the drug has not undergone human studies to ascertain if its use is safe during pregnancy,” says Kecia Gaither, MD, double board-certified OB-GYN and the director of perinatal and maternal-fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York.

Deciding whether to use Dupixent while pregnant should be a shared decision after a thorough discussion between a patient and their healthcare provider. When making decisions about any medication use during pregnancy, Dr. Gaither says there are several factors to consider:

  • Whether the drug is teratogenic (linked to the ability to cause fetal abnormalities)
  • Whether the drug will cause adverse maternal outcomes (such as gestational diabetes, placental abruption, or pregnancy loss)
  • Whether the drug will cause adverse fetal outcomes (such as low birth weight)
  • Whether the drug is excreted in breast milk

Unfortunately, there have been no studies to determine whether Dupixent has any of these characteristics. There is one case report in which dupilumab was used to treat severe eczema in a pregnant patient and caused no harmful effects. Still, one case study is not enough to definitively rule out danger to the fetus when using a systemic medication like Dupixent.

What are the risks of taking Dupixent while pregnant?

Remember, there is not enough research to say Dupixent use is definitely safe or unsafe during pregnancy. However, Dupixent is a monoclonal antibody, so “we can draw on general principles related to monoclonal antibodies,” says Sue Ojageer, Pharm.D., founder of Pharmacy Mentors and a 2022 Best of the Best Pharmacy Awards winner. 

“Monoclonal antibodies like Dupixent are large molecules, and while they are less likely to cross the placenta in the first trimester, the likelihood increases in the second and third trimesters,” Dr. Ojageer explains. That’s why some healthcare providers might recommend discontinuing Dupixent in the later stages of pregnancy. 

Still, just because a drug crosses the placenta does not mean it will cause a miscarriage, fetal abnormality, or premature labor. “While Dupixent’s potential to cross the placenta exists, the data does not currently show a definitive risk of harm,” says Ojageer.

Both doctors emphasize the importance of a team approach to decisions about managing moderate-to-severe eczema, prurigo nodularis, asthma, or eosinophilic esophagitis while pregnant. Together, a healthcare provider and patient can weigh potential benefits against unknown risks to the fetus during Dupixent use. Dr. Gaither suggests that pregnant people with conditions treated by Dupixent should also be under the care of a related specialist (such as a dermatologist for AD) in conjunction with their OB-GYN or maternal-fetal medicine specialist. 

Can you take Dupixent while breastfeeding?

Healthcare providers can’t offer definitive medical guidelines, as there have been no studies on Dupixent use while breastfeeding. It is also not known whether this drug affects lactation. 

According to the FDA, though antibodies are known to travel into breast milk, the risk of an infant’s exposure is unknown. In other words, if a baby did ingest tiny amounts of Dupixent while breastfeeding, experts do not yet know whether it would cause any harm. 

What can I take instead of Dupixent during pregnancy?

“There are a few pregnancy-safe pharmaceuticals for atopic eczema and prurigo nodularis, but none match the efficacy and targeted action of Dupixent,” says Dr. Ojageer. 

The most common Dupixent alternatives are other antibodies or Janus kinase (JAK) inhibitors. Unfortunately, these drugs—Adbry (tralokinumab-ldrm), Cibinqo (abrocitinib), and Rinvoq (upadacitinib), to name a few—also lack studies to verify safety during pregnancy. Still, immunosuppressive therapies are a relatively new treatment for AD, according to the European Task Force for Atopic Dermatitis. 

There are other, more thoroughly researched drugs to treat extreme itchiness and dry skin from eczema and prurigo nodularis, including topical drugs and phototherapy.

Topical drugs

Dr. Ojageer says topical corticosteroids like triamcinolone and calcineurin inhibitors like tacrolimus ointment can relieve symptoms.

“These medications work locally and are less likely to have systemic effects that could impact the pregnancy,” she adds.

Phototherapy

“Phototherapy (narrowband UVB) is another alternative, offering a non-pharmacological option that has been used safely during pregnancy for treating eczema,” says Dr. Ojageer. Also called light therapy, it involves exposing the skin to a specific type of light for brief periods. It is typically an in-office treatment. Although phototherapy can be very effective for some patients, it can take months to produce results, according to the National Eczema Association. Sunburn is also a common side effect of phototherapy. 

Ultimately, pregnant patients who experience worsening symptoms despite trying alternatives to their main AD treatment might consider returning to the use of dupilumab while pregnant, especially if the benefits outweigh the potential risks. Both the pregnant person’s quality of life and the health of the fetus are priorities.