DUPIXENT 200 MG SOLUTION FOR INJECTION IN A PRE-FILLED PEN - patient leaflet, side effects, dosage

1. what dupixent is and what it is used for

What Dupixent is

Dupixent contains the active substance dupilumab.

Dupilumab is a monoclonal antibody (a type of specialised protein) that blocks the action of proteins called IL-4 and IL-13. Both play a major role in causing the signs and symptoms of atopic dermatitis and asthma.

What Dupixent is used for

Dupixent is used to treat adults and adolescents 12 years and older with moderate-to-severe atopic dermatitis, also known as atopic eczema. Dupixent is also used to treat children 6 to 11 years old with severe atopic dermatitis (see section Children and adolescents). Dupixent may be used with eczema medicines that you apply to the skin or it may be used on its own.

Dupixent is used with other asthma medicines for the maintenance treatment of severe asthma in adults and adolescents (12 years of age and older) whose asthma is not controlled with their current asthma medicines.

How Dupixent works

Using Dupixent for atopic dermatitis (atopic eczema) can improve the condition of your skin and reduce itching. Dupixent has also been shown to improve symptoms of pain, anxiety, and depression associated with atopic dermatitis. In addition, Dupixent helps improve your sleep disturbance and overall quality of life.

Dupixent helps prevent severe asthma attacks (exacerbations) and can improve your breathing. Dupixent may also help reduce the amount of another group of medicines you need to control your asthma, called oral corticosteroids, while preventing severe asthma attacks and improving your breathing.

2. what you need to know before you use dupixent

Do not use Dupixent

• – if you are allergic to dupilumab or any of the other ingredients of this medicine (listed in section 6).

• – if you think you may be allergic, or you are not sure, ask your doctor, pharmacist or nurse for advice before using Dupixent.

Warnings and precautions

Talk to your doctor, pharmacist or nurse before using Dupixent:

Dupixent is not a rescue medicine and should not be used to treat a sudden asthma attack.

Allergic reactions

• Rarely, Dupixent can cause serious side effects, including allergic (hypersensitivity) reactions and anaphylactic reaction and angioedema. These reactions can occur from minutes until seven days after Dupixent administration. You must look out for signs of these conditions (i.e. breathing problems, swelling of the face, lips, mouth, throat or tongue, fainting, dizziness, feeling lightheaded (low blood pressure), fever, general ill feeling, swollen lymph nodes, hives, itching, joint pain, skin rash) while you are taking Dupixent. Such signs are listed under “Serious side effects” in section 4.
• Stop using Dupixent and tell your doctor or get medical help immediately if you notice any signs of an allergic reaction.

Eosinophilic conditions

• Rarely patients taking an asthma medicine may develop inflammation of blood vessels or lungs due to an increase of certain white blood cells (eosinophilia).
• It is not known whether this is caused by Dupixent. This usually, but not always, happens in people who also take a steroid medicine which is being stopped or for which the dose is being lowered.
• Tell your doctor immediately if you develop a combination of symptoms such as a flu-like illness, pins and needles or numbness of arms or legs, worsening of pulmonary symptoms, and/or rash.

Parasitic (intestinal parasites) infection

• Dupixent may weaken your resistance to infections caused by parasites. If you already have a parasitic infection it should be treated before you start treatment with Dupixent.
• Check with your doctor if you have diarrhoea, gas, upset stomach, greasy stools, and dehydration which could be a sign of a parasitic infection.
• If you live in a region where these infections are common or if you are travelling to such a region check with your doctor.

Asthma

If you have asthma and are taking asthma medicines, do not change or stop your asthma medicine without talking to your doctor. Talk to your doctor before you stop Dupixent or if your asthma remains uncontrolled or worsens during treatment with this medicine.

Eye problems

Talk to your doctor if you have any new or worsening eye problems, including eye pain or changes in vision.

Children and adolescents

• The Dupixent pre-filled pen is not intended for use in children below 12 years of age. For children aged 6–11 years with atopic dermatitis, contact your doctor who will prescribe the appropriate Dupixent pre-filled syringe.
• The safety and benefits of Dupixent are not yet known in children with atopic dermatitis below the age of 6.
• The safety and benefits of Dupixent are not yet known in children with asthma below the age of 12.

Other medicines and Dupixent

Tell your doctor or pharmacist

• if you are using, have recently used or might use any other medicines.
• if you have recently had or are due to have a vaccination.

Other medicines for asthma

Do not stop or reduce your asthma medicines, unless instructed by your doctor.

• These medicines (especially ones called corticosteroids) must be stopped gradually.
• This must be done under the direct supervision of your doctor and dependent on your response to Dupixent.
• If you are pregnant, think you may be pregnant, or are planning to have a baby, ask your doctor for advice before using this medicine. The effects of this medicine in pregnant women are not known; therefore it is preferable to avoid the use of Dupixent in pregnancy unless your doctor advises to use it.
• If you are breast-feeding or are planning to breast-feed, talk to your doctor before using this medicine. You and your doctor should decide if you will breast-feed or use Dupixent. You should not do both.

Driving and using machines

Dupixent is unlikely to influence your ability to drive and use machines.

Dupixent contains sodium

This medicine contains less than 1 mmol sodium (23 mg) per 200 mg dose, i.e., it is essentially “sodium-free”.

3. how to use dupixent

Always use this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

How Dupixent is given

Dupixent is given by injection under the skin (subcutaneous injection).

How much Dupixent you will receive

Your doctor will decide which dose of Dupixent is right for you.

Recommended dose in adolescents with atopic dermatitis

The recommended dose of Dupixent for adolescents (12 to 17 years of age) with atopic dermatitis is based on body weight:

Body Weight of Patient	Initial Dose	Subsequent Doses (every other week)
less than 60 kg	400 mg (two 200 mg injections)	200 mg
60 kg or more	600 mg (two 300 mg injections)	300 mg

Recommended dose in children with atopic dermatitis

The recommended dose of Dupixent for children (6 to 11 years of age) with atopic dermatitis is based on body weight:

Body Weight of Patient	Initial Dose	Subsequent Doses
15 kg to less than 60 kg	300 mg (one 300 mg injection) on Day 1, followed by 300 mg on Day 15	300 mg every 4 weeks* , starting 4 weeks after Day 15 dose
60 kg or more	600 mg (two 300 mg injections)	300 mg every other week

* The dose may be increased to 200 mg every other week based on the doctor’s opinion.

Recommended dose in adult and adolescent patients with asthma (12 years of age and older) For most patients with severe asthma, the recommended dose of Dupixent is:

• An initial dose of 400 mg (two 200 mg injections)
• Followed by 200 mg given every other week administered as subcutaneous injection.

For patients with severe asthma and who are on oral corticosteroids or for patients with severe asthma and co-morbid moderate-to-severe atopic dermatitis or adults with co-morbid severe chronic rhinosinusitis with nasal polyposis the recommended dose of Dupixent is:

• An initial dose of 600 mg (two 300 mg injections)
• Followed by 300 mg given every other week administered as subcutaneous injection.

Injecting Dupixent

Dupixent is given by injection under your skin (subcutaneous injection). You and your doctor or nurse should decide if you should inject Dupixent yourself.

Before injecting Dupixent yourself you must have been properly trained by your doctor or nurse.

Your Dupixent injection may also be given by a caregiver after proper training by a doctor or nurse.

Each pre-filled pen contains one dose of Dupixent (200 mg). Do not shake the pre-filled pen.

Read the “Instructions for Use” for the pre-filled pen carefully before using Dupixent.

5. How to store Dupixent

If you use more Dupixent than you should

If you use more Dupixent than you should or the dose has been given too early, talk to your doctor, pharmacist or nurse.

If you forget to use Dupixent

If you have forgotten to inject a dose of Dupixent, talk to your doctor, pharmacist or nurse.

If you stop using Dupixent

Do not stop using Dupixent without speaking to your doctor first.

If you have any further questions on the use of this medicine, ask your doctor, pharmacist or nurse.

4. possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Dupixent can cause serious side effects, including rare allergic (hypersensitivity) reactions, including anaphylactic reaction; the signs of allergic reaction or anaphylactic reaction may include:

• breathing problems
• swelling of the face, lips, mouth, throat or tongue (angioedema)
• fainting, dizziness, feeling lightheaded (low blood pressure)
• fever
• general ill feeling
• swollen lymph nodes
• hives
• itching
• joint pain
• skin rash

If you develop an allergic reaction, stop using Dupixent and talk to your doctor right away.

Other side effects

Common (may affect up to 1 in 10 people):

• injection site reactions (i.e. redness, swelling, itching, pain)
• eye dryness, redness and itching
• eye infection
• cold sores (on lips and skin)
• joint pain (arthralgia)

Uncommon (may affect up to 1 in 100 people):

• swelling of the face, lips, mouth, throat or tongue (angioedema)
• eyelid itching, redness and swelling
• inflammation of the eye surface, sometimes with blurred vision (keratitis)

Rare (may affect up to 1 in 1,000 people):

• ulcers on the outer clear layer of the eye, sometimes with blurred vision (ulcerative keratitis)

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: or search for MHRA in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the label and carton after EXP. The expiry date refers to the last day of that month.

Store in a refrigerator (2°C to 8°C). If necessary, pre-filled pens may be kept at room temperature up to 25°C for a maximum of 14 days. Do not store above 25°C. If you need to permanently remove the carton from the refrigerator, write down the date of removal in the space provided on the outer carton, and use Dupixent within 14 days.

Store in the original carton to protect from light.

Do not use this medicine if you notice that the medicine is cloudy, discoloured, or has particles in it.

Do not throw away any medicines via wastewater or household waste. Ask your doctor, pharmacist or nurse how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Dupixent contains

• – The active substance is dupilumab.

• – Each pre-filled pen contains 200 mg of dupilumab in 1.14 ml solution for injection (injection).

• – The other ingredients are arginine hydrochloride, histidine, polysorbate 80 (E433), sodium acetate, glacial acetic acid (E260), sucrose, water for injections.

What Dupixent looks like and contents of the pack

Dupixent is a clear to slightly opalescent, colourless to pale yellow solution supplied in a pre-filled pen.

Dupixent is available as 200 mg pre-filled pens in a pack containing 1, 2, 3, or 6 pre-filled pens.

Not all pack sizes may be marketed.

Marketing Authorisation Holder sanofi-aventis groupe 54, rue La Boetie 75008 Paris France

Manufacturer

Sanofi-Aventis Deutschland GmbH

Bruningstrasse 50

Industriepark Hoechst 65926 FRANKFURT AM MAIN GERMANY

This leaflet was last revised in June 2021

Detailed information on this medicine is available on the European Medicines Agency web site:

How to Store Dupixent

Instructions for use

- J

|b

C Give injection

) (d

Pull the yellow cap straight off.

Do not twist the yellow cap off.

Do not remove the yellow cap until you are ready to inject.

Do not press or touch the orange needle cover with your fingers. The needle is inside.

I Do not put the yellow cap back on the pre-filled pen after you have removed it.

■ When placing the orange needle cover on your skin, hold the pre-filled pen so that you can see the window.

Place the orange needle cover on your skin at approximately a 90-degree angle.

! Do not press or touch the orange needle cover with your fingers. The needle is inside.

Press the pre-filled pen firmly against your skin until you cannot see the orange needle cover, and hold.

• There will be a “click” when the injection starts.
• The window will start to turn yellow.

The injection can take up to 20 seconds.

Keep holding the pre-filled pen firmly against your skin.

• You may hear a second click.
• Check that the entire window has turned to yellow.
• Then slowly count to 5.
• Then lift the pen up off the skin, your injection is complete.

If the window does not turn completely yellow, remove the pen and call your healthcare provider.

• After you have completed your injection pull straight up to remove pre-filled pen from the skin and dispose of immediately as described in section D.
• If you see any blood at the site, lightly dab a cotton ball or gauze pad.

! Do not rub your skin after the injection.

• Dispose of the pre-filled pens, (needle inside), and yellow caps in a puncture resistant container right away after use.

Do not dispose of (throw away) pre-filled pens (needle inside), and yellow caps in your household trash.

I Do not put the yellow cap back on.

I Do not give yourself a second dose without speaking to your healthcare provider.