Dr. Ahmed
Nucala Vs Dupixent is a comparison of the two potent biologic medicines, Mepolizumab and Dupilumab, recently approved by the FDA. Their efficacies in the treatment of asthma and nasal polyps are compared at the end of the article.
Nucala and Dupixent are biological drugs that are used for multiple disorders. Both of them are formed from a single clone of cells by the process of recombinant DNA technology.
Mepolizumab is present in the market as a Nucala drug, while Dupilumab is present as a Dupixent.
They are used for conditions like uncontrolled eosinophilic or allergic asthma, eczema, nasal polyps, hypereosinophilic disorder, eosinophilic granulomatosis, and other allergic reactions.
Dupilumab is derived from humans while Mepolizumab is derived from humanized mouse clones.
Mechanism of action of Nucala Vs Dupixent:
Interleukin 4 is composed of two types of receptors. Both of these receptors contain a standard IL-4R alpha chain. This IL-4R alpha element is present in IL-13 as well.
Dupilumab works by limiting the signaling process of these two interleukins by inhibiting the IL-4R alpha component.
IL-4 is the most important cytokine and it activates the immune system in response to an allergen.
So by inhibition of IL-4, allergic inflammation is stopped. Apart from this, Dupilumab also restricts the functioning of IL-13 which is a potential mediator of excess mucus production, and eosinophilic inflammation in the lungs; both are asthma symptoms.
Mepolizumab works by inhibiting the normal functioning of interleukin 5. IL-5 is very important for the maturation of eosinophils, and their secretion into the blood as well.
It binds to their respective receptor which is present on the surface of eosinophils. When mepolizumab is given to patients, it attacks the eosinophils by binding to them, resulting in a decreased number of eosinophils in blood and tissue.
As eosinophils are the main culprit cells that are involved in the pathogenesis of allergic asthma. Lowering their number significantly reduces the inflammation in the airways caused by eosinophils.
Basic differences between Dupixent and Nucala
Dupixent is used to treat asthma and atopic dermatitis which is also known as eczema in which the skin becomes dry and red with itching all over the skin.
In contrast, Nucala is only used to reduce the symptoms of asthma which includes chest tightness, coughing, wheezing, etc.
Dupilumab by inhibiting the signaling of interleukin 3 and 14, blocks the JAK-STAT pathway which is one of the main processes of causing atopic dermatitis.
It is usually used when other medications like topical drugs which include ointments, lotions, or creams do not give desirable effects.
Mepolizumab basically works by targetting the interleukin 5. It neutralizes the effects of this cytokine which is an integral entity for causing inflammatory diseases.
Also, this cytokine is involved in increasing the number of eosinophils when the body is encountered by any foreign body capable of activating the immune system, resulting in hypereosinophilia syndrome.
Live vaccines can not be administered to individuals who are on Dupixent. Non-live vaccines and polysaccharide vaccines can be administered. There are no such contraindications mentioned by the Nucala manufacturers.
Covid vaccines can be administered by both Nucala and Dupixent users.
Dupixent Atopic Dermatitis Dosing and Dose in Allergic Asthma
Similarities between Nucala and Dupilumab
- Both Nucala and Dupixent are biological drugs obtained from the process of recombinant DNA technology.
- Both are monoclonal antibodies which means they are obtained from a single clone of cells.
- Both of these can be used to treat asthma and long-standing rhinosinusitis with nasal polyps.
- Both of these are interleukin inhibitors.
- Both of these have some common side effects as well.
- Both of these are given to the patients subcutaneously.
FDA-approved Indications | Nucala | Dupixent |
| Asthma | Yes | Yes |
| Chronic rhinosinusitis and nasal polyps | Yes | Yes |
| Atopic Dermatitis | No | Yes |
| Eosinophilic esophagitis | No | Yes |
| Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) | Yes | No |
| Hyper-eosinophilic syndromes | Yes | No |
Differences in the side effects of Nucala Vs Dupixent:
Dupixent:
- Burning sensations in the eyes and the eyes become dry as well in most cases.
- Extreme tearing is also a side effect.
- Blood vessels may get inflamed.
- Distended glands appear after its administration.
- Insomnia is undoubtedly its side effect.
- Dark-colored stools are one of the significant side effects of Dupixent.
- Inflammation of the membrane in the eye results in the pink color of the eye and this state is also known as conjunctivitis.
- Viral infections like herpes simple have also been seen.
- Infections in the stomach, teeth, or pharynx have been reported.
- Eosinophilic pneumonia is its respiratory drawback.
Dupixent Side effects Red Face: Dupilumab Facial Redness (DFR)
Nucala:
- Pain in the body especially in the back.
- Muscle pain also occurs.
- Sometimes blood is also there in the urine.
- Pain in the joints as well.
- Loss of appetite.
- Cases of pruritus along with eczema have been seen as well.
- Antibodies against mepolizumab are also produced after its administration resulting in influenza.
- Pain in the upper abdomen is common.
- Infection in the lower respiratory tract and pharynx, and nasal congestion are the respiratory side effects of Nucala.
Common side effects:
- hives, itching, and redness on the skin.
- Injection spot infection is the most common side effect of both.
- Loss of sensation in arms and legs.
- Sweating
- Headache is one of the most common side effects of these drugs.
How to administer Nucala Vs Dupixent?
NUCALA is given with the help of injection and the dose is 100 mg for the patient 12 or older regardless of his/her weight. Once after four weeks is prescribed by the doctor and the patient itself can inject it easily if he/she is directed by the caregiver.
Dupixent is administered subcutaneously by two injections, each of 300 mg, and after receiving it, one injection of 300 mg per week is required by the patient.
Both Nucala and Dupixent are available as pen autoinjectors and syringes.
Precautions while administering Nucala and dupixent
If you are already exposed to some infections or your body is under severe stress, do not use Nucala as it lowers the concentration of some white blood cells and your immune system becomes weak. Dispose of the dose of Nucala if not used within 8 hours.
In the case of Dupixent, if you are having joint aches already, do not use Dupixent as it can make this pain worse than before.
Avoid the usage of Dupixent in children less than 6 years as their immune systems are already weak and they can not fight if some infections caught them. Similarly, avoid it in pregnancy.
Efficacy of Nucala Vs Dupixent
Although both Nucala and Dupixent are safe and effective to use, there is a little bit of difference in their effectiveness.
Efficacies can only be compared if the two drugs are compared in a head-to-head comparison trial. Some inferences can still be made in this regard from individual studies.
Why Does Dupixent Hurt So Much? How to Make Dupixent Hurt Less?
Nucala Vs Dupixent for Atopic Dermatitis:
Nucala is not used to treat atopic dermatitis. Dupixent is one of the turning points and life-changing drugs for patients with atopic dermatitis that is resistant to conventional treatment.
It was found effective in about 60% of the patients compared to only 10% of the placebo responders.
Nucala Vs Dupixent for Asthma:
Both Nucala and Dupixent have been approved for the treatment of Allergic asthma (Eosinophilic asthma).
Compared to a placebo medicine, both these drugs are quite effective in patients with moderate to severe asthma.
Which drug is more effective? Because the two drugs have not been tested in a head-to-head comparison trial, it is difficult to answer this question.
However, data from clinical trials favor Dupixent rather than Nucala for the treatment of moderate to severe allergic asthma [Ref]
Asthma | Nucala | Dupixent | Winner? |
| Reduction in Asthma exacerbations | Yes. The ratio of asthma exacerbations in the Nucala: placebo ranged from 0.40 to 0.68 | Yes. The ratio of asthma exacerbations in the Dupixent: placebo ranged from 0.19 to 0.34 | Dupixent 🏆 |
| Improvement in FEV1 | 98 ml at week 32 | 140 ml (9%) at week 12 | Dupixent 🏆 |
| Reduction in corticosteroid dose | 23% in the Nucala group vs 11% in the placebo were completely off OCS at week 24 | 52% in the Dupixent group vs 29% in the placebo group were completely off OCS at week 24 | Dupixent 🏆 |
Nucala Vs Dupixent for Nasal polyps:
Nucala Vs Dupixent are both approved biological medicines for the treatment of chronic sinusitis with nasal polyps.
Compared to a placebo medicine, both drugs are very effective in relieving the symptoms of nasal polyps and nasal congestion.
Which drug is better for Nasal polyps: Nucala or Dupixent? It is difficult to answer this as the two drugs have not been compared in a head-to-head comparison trial.
However, data in separate trials are concluded here in the table below:
Nasal polyps | Nucala | Dupixent | Winner |
| Improvement in nasal congestion | Yes | Yes | Nucala 🏆 |
| Improvement in NOS at week 52 vs placebo | -1.86 | -0.98 | |
| Improvement in nasal polyps score | Yes | Yes | Dupixent 🏆 |
| Improvement in NPS vs placebo | -0.93 at week 52 | -2.06 at week 24 |
Nucala Vs Dupixent for Eosinophilic esophagitis:
Nucala is not FDA-approved for the treatment of Eosinophilic esophagitis. Contrary to that, Dupixent has been very recently approved by the FDA for the treatment of Eosinophilic esophagitis.
Nucala Vs Dupixent for Eosinophilic Granulomatosis with polyangiitis:
Nucala is FDA-approved for the treatment of Eosinophilic granulomatosis with polyangiitis. Dupixent is not approved for this condition.
Nucala Vs Dupixent for Hypereosinophilic syndrome:
Nucala is FDA approved for the treatment of the non-hematological causes of hypereosinophilic syndrome that has been present for at least six months or more.
Dupixent has not been FDA approved for this condition.
