If you Google the question above, you get some interesting and disturbing answers. Both Healthline and drugs.com claim that Dupixent is NOT an immunosuppressant. The drugs.com article goes on to state, “Dupixent calms an overreactive immune system but does not suppress the immune system.”
Can someone please explain to me the difference between calming the immune system and suppressing it? Sounds like some serious marketing antics to me. But I guess if your site is drugs.com, then we can guess which side your bias lies. Nonetheless, I think it’s worth exploring.
What is Dupixent?
Dupixent (generic dupilumab) is becoming a very common (and expensive) prescribed drug to treat eczema. We hear from dozens of patients and clients each day who are either using dupixent for themselves or a family member (usually a child), or have been told by their physician, allergist, or dermatologist that it is their next best step.
When patients ask their doctor, “but isn’t Dupixent an immunosuppressant?”, they are quickly told, “No, it’s not an immunosuppressant. It’s a biologic.”
Once again, absolute marketing genius on the part of Sanofi, the pharmaceutical giant behind dupixent. Reminds me of when Purdue, the pharmaceutical giant that was recently fined billions in the opioid crisis, told doctors and the public that Oxycontin has an “extremely low risk of addiction”. How about when doctors promoted smoking cigarettes?
To get some clarity on this, I think we need to examine what the term “immunosuppressant” really means.
What is an immunosuppressant?
Oxford’s dictionary defines an immunosuppressant as a drug that suppresses the immune response of an individual.
The Cleveland clinic website states, “Immunosuppressants are drugs that keep your immune system in check.”
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/immunosuppressive-agent tells us an immunosuppressant is “An agent that decreases the body’s immune responses.”
The term immunosuppressant was originally popularized in the late fifties and sixties to describe drugs used to manage organ transplant patients. These patients needed their immune systems significantly reduced so that they would not attack their new organs.
The original drugs used to do this had some pretty terrible side effects, and many patients died as a result of the immunosuppressive drugs, rather than the actual organ transplant. The world of immunosuppressive agents has progressed quite a bit since the early days, and the most current phase of these drugs is known as “immunopharmacology” according to the Encyclopedia of Immunology.
These newer “immunosuppressive agents” are able to target specific areas of the immune system, rather than attacking the entire thing. They are also made from living organisms (rather than synthetically) so they are termed “biologics”.
But, is Dupixent an immunosuppressant?
Interestingly, the American Academy of Allergy, Asthma, and Immunology lists Dupixent on its list of “Immunosuppressive Medication for the Treatment of Autoimmune Disease”. “The American Academy of Allergy, Asthma & Immunology (AAAAI) is the leading membership organization of more than 7,000 allergists/immunologists and patients’ trusted resource for allergies, asthma and immune deficiency disorders” according to their website.
Here is where the smoke and mirrors start.
According to the Sanofi/Dupixent website,
“DUPIXENT is the first and only dual inhibitor of IL-4 and IL-13 signaling. IL-4 and IL-13 are key drivers of local and systemic type 2 inflammation”.
The image above is from the dupixent website. Directly above the description of how the drug inhibits the immune system, it states “DUPIXENT IS NOT AN IMMUNOSUPPRESSANT”.
IL-4 and IL-13 stands for Interleukin-4 and Interleukin-13. Interleukins are proteins produced by white blood cells that help in regulating immune responses.
So Dupixent blocks the function of 2 proteins important in regulating immune responses but is not an immunosuppressant???!!
We have to call BS on that.
Additionally, IL-4 and IL-13 are important for fighting certain parasitic infections. The prescribing information states that the ability to fight parasitic infections is likely reduced when on Dupixent.
The prescribing info also states to “avoid the use of live vaccines” such as MMR, varicella, rotavirus, and influenza (intranasal).
If Dupixent supposedly does NOT suppress the immune system, then why would these restrictions be placed on the drug?
At this point lets at least address the big hairy elephant in the room – any drug that blocks portions of the immune system is technically an immunosuppressant. That’s what the word actually means.
Dupixent Side Effects
In addition to the aforementioned immunosuppressive issues, Dupixent carries a variety of other side effects including but not limited to:
Injection site reactions, conjunctivitis, blepharitis, oral herpes, keratitis, eye pruritus, other herpes simplex virus infection, dry eye, oropharyngeal pain, eosinophilia, insomnia, toothache, gastritis, arthralgia, upper respiratory tract infections, arthralgia, and herpes viral infections, nasopharyngitis, dizziness, myalgia, and diarrhea.
A patient or parent absolutely has the right to determine if a drug like Dupixent is right for themselves or their family. You are not a bad parent if you choose it or don’t choose it. But lets at least give parents all the facts straight up. This medication is approved and recommended for 6-month-old babies. This is not the place for smoke and mirrors.
In eczema, there are reasons that the interleukins and parts of the immune system are malfunctioning. If we get to the root cause of eczema, patients can heal their immune system and subsequently their eczema, without having to block important parts of the system. When I see a person with eczema, my initial thought is not which drug can I use to block their immune system. My first thought is “what is stirring up the immune system and what lifestyle factors can we begin to implement in order to simmer down this out-of-control situation?”
There is a reason why the United States has one of the highest rates of eczema in the world – and it is NOT genetics. An immigrant who moves here develops the same elevated risk of eczema as an American native within 10 years of being here. That is a lifestyle and environment folks – not genetics.
What can I do to heal Eczema instead of using Dupixent?
I have lectured extensively on an alternative way to approach eczema that reduces toxic, IMMUNOSUPPRESSIVE agents like Dupixent. My 4 pillars to optimize the immune system and heal eczema include:
- Gut Retraining – ⅔ of the immune system lies in the gut
- Enviro-toxin reduction
- Skin Rebalancing
- Robust support