Encyclopedia · immunomodulator
Dupilumab
An eczema antibody that halted worsening of alopecia areata in a 40-person phase 2a trial, especially in people with high IgE, although absolute regrowth rates were modest.
What it is
A prescription injectable approved for eczema and other type 2 allergic diseases. For alopecia areata it is off-label.
How it works
It blocks IL-4 and IL-13 receptor signalling (the Th2 allergy axis). It was tested because people with alopecia areata and atopy show Th2 immune signatures.
What the studies show
- In a phase 2a randomized trial (40 on dupilumab vs 20 on placebo; 300 mg weekly for 24 weeks, then open label), the placebo group worsened (SALT score change -6.5) while the dupilumab group stayed about stable (+2.2). Guttman-Yassky 2022
- At 48 weeks, 32.5% reached a 30% improvement in SALT score, 22.5% reached 50% and 15% reached 75%. In people with IgE of at least 200 IU/ml the figures were 53.8%, 46.2% and 38.5%, and IgE predicted response with 83% accuracy. Guttman-Yassky 2022
How it's used in studies
300 mg by injection under the skin weekly.
Side effects and safety
No new safety signals in the trial. Check the label for the usual injection-site and eye effects.
Bottom line
Far weaker than JAK inhibitors, and mainly relevant for alopecia areata with allergic disease or high IgE. Discuss with a doctor.
Fun facts
- An eczema drug nearly froze alopecia areata progression, and baseline IgE predicted who responded with 83% accuracy. Guttman-Yassky 2022
Studies 1
Guttman-Yassky E et al. A phase 2a randomized clinical trial of dupilumab for alopecia areata. Allergy. 2022
Tested: dupilumab 300 mg weekly vs placebo
Result: Placebo worsened (SALT -6.5) while dupilumab stayed about stable (+2.2); at 48 weeks 32.5% reached SALT30; IgE of 200 IU/ml or more predicted response.
Read the study ↗Related
- TofacitinibThe first JAK inhibitor used off-label for alopecia areata; about a third to two thirds of patients regrow hair in open-label studies, but most relapse within months of stopping.
- BaricitinibA once-daily pill that was the first drug approved for severe alopecia areata, regrowing hair in about a third of patients while they keep taking it.
- RitlecitinibA once-daily pill approved for severe alopecia areata from age 12, which regrows hair in about 1 in 4 people by 6 months and keeps improving for years.
- TNF inhibitors (adalimumab, infliximab, etanercept)Anti-inflammatory biologics that can paradoxically trigger alopecia areata or scarring hair loss, even though etanercept regrew no hair in any of 17 patients when tested as an alopecia areata treatment.