Dupilumab (Dupixent) dose for asthma:
Indicated as an add-on maintenance treatment for moderate-to-severe asthma in patients aged 12 years and older with eosinophilic phenotype or PO corticosteroid dependent asthma:
- 400 mg SC once, then 200 mg q2weeks, OR
- 600 mg SC once, then 300 mg q2weeks
For patients with PO corticosteroid-dependent asthma or comorbid moderate-to-severe atopic dermatitis (for which dupilumab is indicated), administer 600 mg initial dose then 300 mg q2weeks.
The answer is:
- 200 mg maintenance dose is for moderate-to-severe asthma with eosinophilic phenotype
- 300 mg maintenance dose is for PO corticosteroid-dependent asthma or comorbid moderate-to-severe atopic dermatitis
You could use 300 mg for moderate-to-severe asthma with eosinophilic phenotype, but the NEJM graph here shows that the doses response curves run parallel to each other and there is not benefit of the higher dose: https://www.nejm.org/doi/full/10.1056/NEJMoa1804092#figures_media
Chief Scientific Officer of Regeneron regards these as 2 separate groups: "Dupixent is now approved in the U.S. for two important groups of uncontrolled asthma patients – those who are moderate-to-severe with an eosinophilic phenotype or those with oral corticosteroid-dependent asthma".
Asthma Treatment Options (click to enlarge the image).
Dupixent is expected to be approved for chronic sinusitis at the 300 mg dose. (https://www.ncbi.nlm.nih.gov/pubmed/26836729)
The lowest GoodRx price for the most common version of Dupixent (300 mg) is $3,000 as of 2018, this dose is administered every 2 weeks (https://www.goodrx.com/dupixent). The monthly cost is $6,000.