Do you avoid dupilumab (IL-4 inhibition) for severe asthma in patients already taking a biologic agent for RA?

Dupixent (dupilumab) is a humanized monoclonal IgG4 antibody that works by blocking the signaling of interleukin-4 (IL-4) and interleukin-13 (IL-13). This is achieved by binding to the IL-4Rα subunit. When dupilumab occupies this subunit, it prevents IL-4 signaling via the Type I receptor and both IL-4 and IL-13 signaling through the Type II receptor. It is not unusual for some of our RA patients to be prescribed this drug for atopic dermatitis or asthma.

To date, there is no evidence that dupilumab reactivates latent infections, such as tuberculosis or hepatitis B, increases the risk of invasive fungal infections or unusual opportunistic infections, nor increases the progression of cancer.

My limited anecdotal experience supports this finding and I have not witnessed a heightened incidence of infection in my RA patients treated with a combination of dupilumab and a biologic drug.