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Comparing Dupixent vs Cyclosporin for Atopic Dermatitis

Dupixent vs Cyclosporin

Atopic dermatitis (AD), popularly known as eczema, is a chronic inflammatory skin condition. It is characterized by intense itching, red and inflamed skin, and disruptions to the skin barrier function.

It seriously affects the quality of life because of sleep disturbances, emotional distress, and secondary infections. Therefore, the effective management of AD requires long-term treatment strategies that are adapted to the specific needs of individual patients.

Some patients with atopic dermatitis, whether moderate to severe, get treated with either Dupixent, Cyclosporin, or both. Both medications are excellent in providing relief, but the mechanisms, effectiveness, and safety profiles may vary.

Dupixent vs Cyclosporin is a comparison of these two drugs for the treatment of eczema.

What is Dupixent (Dupilumab)?

Dupixent injection via prefilled pen device into the thighs
Dupixent injection via prefilled pen device into the thighs

Dupixent is a biologic medication that targets the immune pathways responsible for inflammation in atopic dermatitis.

It is a monoclonal antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13), two cytokines implicated in the pathogenesis of AD.

Blocking these interleukins, Dupixent reduces inflammation, itching, and skin barrier dysfunction. This way, it addresses the root cause of atopic dermatitis rather than just suppressing the symptoms.

Long-term treatment with Dupixent is considered to be a method of maintaining control over the disease and preventing flare-ups. This drug is administered subcutaneously every two weeks by the patients themselves, thus making it more convenient.

What is Cyclosporin (Cyclosporine A)?

Cyclosporin is a compound immunosuppressant that functions as a T-cell activation inhibitor via blockage of the enzyme calcineurin, which acts crucial for immune function, leading to an immune overreaction that creates inflammatory manifestations of atopic dermatitis.

However, because calcineurin is involved in multiple immune functions, Cyclosporin has broader immunosuppressive effects, increasing the risk of infections and other systemic side effects.

Unlike Dupixent, Cyclosporin is typically used for short-term symptom control, generally prescribed for six months to one year, rather than ongoing maintenance therapy due to potential toxicity.

 Dupixent vs. Cyclosporin

FeatureDupixent (Dupilumab)Cyclosporin (Cyclosporine A)
Mechanism of ActionIL-4 and IL-13 inhibition (biologic)Calcineurin inhibition (immunosuppressant)
Route of AdministrationSubcutaneous injection (every 2 weeks)Oral (daily)
Onset of Action2–4 weeks2–6 weeks
EffectivenessSustained long-term controlEffective for short-term use
Side EffectsInjection site reactions, conjunctivitis, mild infectionsHypertension, kidney toxicity, increased infection risk
Safety ProfileHigh long-term safety, no immunosuppressionRequires monitoring for toxicity, immune suppression risk
Long-term UseApproved for long-term useNot recommended for long-term use due to toxicity risk
CostExpensive; insurance coverage variesLess expensive but requires monitoring costs
FDA Approval for ADApprovedApproved, but used off-label in some cases

Pediatric and Geriatric Use

Both Dupixent and Cyclosporin have been used in different age groups but with some variations:

Pediatric Patients

  • Dupixent is FDA-approved for children aged 6 years and older with moderate-to-severe atopic dermatitis.
  • Cyclosporin is often used off-label in children, but its long-term safety in pediatric patients is a concern due to potential toxicity.
  • Pediatric patients on Cyclosporin require frequent monitoring to mitigate adverse effects.

Geriatric Patients

  • Dupixent is generally well-tolerated in older adults and does not require dose adjustments.
  • Cyclosporin use in elderly patients is more cautious due to increased risks of hypertension, kidney dysfunction, and infections.

Dupixent vs Cyclosporin – Effectiveness and Clinical Outcomes

Dupixent’s Long-Term Benefits

Clinical trials reveal that Dupixent results in the marked and long-term symptom improvement of eczema.

Patients tend to have diminished itching, inflammation, and restoration of the skin barrier. Unlike immunosuppressives, Dupixent does not require routine monitoring of blood components, making its use ideal in long-term treatments.

It is also known to have high compliance rates among patients due to a lack of unpleasant side effects associated with its treatment. [Ref]

A study showed that more than 70% of patients with moderate-to-severe atopic dermatitis improved their Investigator Global Assessment (IGA) score from ≥3 to ≤2 after four months of Dupixent treatment.

dupixent for eczema

Additionally, 42.8% achieved nearly clear or clear skin (IGA 0/1). Patients also experienced significant reductions in itch severity (from a mean score of 7.0 to 2.8) and body surface area (BSA) affected by eczema (from 39.3% to 16.3%) within the same timeframe. [Ref]

A South Korean study demonstrated a high four-year drug survival rate for Dupixent at 87.9%. This indicates long-term adherence and effectiveness, with predictors of shorter survival including lower baseline Eczema Area and Severity Index (EASI) scores.

Similarly, in a Chinese real-world cohort, Dupixent maintained significant efficacy over 52 weeks, with many patients achieving EASI-50 and EASI-75 scores, reflecting substantial improvements in disease severity. [Ref]

Another study highlighted that Dupixent is effective and safe even in patients with comorbidities like malignancy or asthma.

Among these patients, 64% achieved clear or almost clear skin after one year of treatment, with minimal adverse effects reported.

Furthermore, real-world persistence rates for Dupixent were higher compared to other biologics used for similar conditions, such as psoriasis, suggesting better patient adherence due to its effectiveness and tolerability. [Ref]

Cyclosporin’s Rapid but Temporary Relief

Cyclosporin provides rapid symptom relief within weeks, but its use is limited to short-term treatment (typically 1 year or less) due to potential toxicity.

It is beneficial for patients needing immediate symptom control when other treatments fail. However, upon discontinuation, symptoms often return quickly, requiring alternative long-term treatment solutions.

Patients on Cyclosporin require frequent blood tests to monitor kidney function and blood pressure due to the risk of nephrotoxicity and hypertension.

Moreover, studies suggest that a low dose of Cyclosporin is related to lesser side effects as compared to a higher dose. [Ref]

Which One Should You Choose?

When to Choose Dupixent

  • Patients requiring long-term control of atopic dermatitis
  • Individuals seeking a non-immunosuppressive treatment
  • Those who prefer less frequent dosing and no blood monitoring

When to Choose Cyclosporin

  • Patients needing rapid symptom relief
  • Individuals who do not have access to or cannot afford Dupixent
  • Short-term use cases where monitoring is manageable

Dupilumab and Cyclosporin combined have been shown to have superior efficacy in the treatment of eczema, acne, and pruritus.

Your doctor will decide which treatment is best for you. Knowing the differences between Dupilumab and Cyclosporin is important before opting for a treatment.

Conclusion

Both Dupixent and Cyclosporin offer significant benefits for patients with moderate-to-severe atopic dermatitis.

While Dupixent is the preferred long-term solution due to its targeted approach and favorable safety profile, Cyclosporin remains a viable short-term treatment for rapid symptom control.

Continued advancements in dermatologic treatments may further improve options available for atopic dermatitis management in the future.



What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

Here is a link to My Facebook Page. You can also contact me by email at contact@dibesity.com or at My Twitter Account
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