Navigating Bullous Pemphigoid: What to Know About Dupixent

Written by Patricia Weiser, PharmD
Medically Reviewed by Beth Johnston, PharmD, BCPS on July 21, 2025
8 min read

Bullous pemphigoid (BP) is an autoimmune disorder that mainly affects older adults. The condition causes your immune system to attack proteins that hold the layers of your skin together. This damages the barrier between the layers of your skin. Symptoms of BP include an itchy rash with large, fluid-filled skin blisters all over your body. The itchiness can be intense, and the blisters may become painful or break open, increasing the risk of infection. The symptoms can lead to poor sleep and emotional distress.

Until recently, there were no specific medicines to treat BP. For years, the main treatments have involved steroid creams or pills and other medicines to help ease symptoms. But these medicines tend to cause bad side effects if used long term, especially in older adults. 

Scientists do not know the exact cause of BP. Recently, researchers discovered that BP may be driven by a type of inflammatory response similar to the inflammation seen in other conditions like eczema.

In June 2025, Dupixent (dupilumab) became the first medicine specifically approved to treat BP in adults. It is given as a shot and works throughout the body to help reduce inflammation. It works by blocking certain pathways in your immune system.

Dupixent is also commonly used to treat other conditions, such as asthma and eczema. This article focuses on frequently asked questions about Dupixent for bullous pemphigoid.

Dupixent is FDA-approved to treat bullous pemphigoid (BP) in adults. It is not approved for this use in children.

If you have BP, talk with your health care provider. Together, you can decide if this medicine is right for you.

No, Dupixent is not a steroid. It is a type of biologic medicine and belongs to a drug class called interleukin (IL) receptor antagonists. It works throughout the body to help reduce inflammation by blocking certain pathways in your immune system.

More specifically, Dupixent is thought to work for bullous pemphigoid (BP) by blocking two proteins in the body called IL-4 and IL-13. These proteins are involved in a type of inflammation known as type 2 inflammation, and they seem to play a major role in causing symptoms of BP including itchy, painful blisters and skin damage. People with BP may have high levels of IL-4, IL-13, and other markers of this type of inflammation in their skin and blood. By calming this type of inflammation, Dupixent may stop or reduce symptoms of BP. 

While the exact way it works is not fully understood, studies show that Dupixent may help people with BP reach what is called sustained remission. This means no new blisters are forming, old ones are healing, and itchiness is going away.

Dupixent comes as a liquid in a single-dose, prefilled pen or a single-dose prefilled syringe. With proper training, you or a caregiver can inject Dupixent at home. It is given as an injection under the skin (subcutaneous). It can be given under the skin of your thigh, stomach (not within 2 inches of your belly button), or the outer area of your upper arm (with a caregiver’s help). 

Your health care provider will show you how to give Dupixent injections. To review the details, you can refer to the Instructions for Use that come with your prescription.

To treat BP, most people use Dupixent once every two weeks. The first dose is usually 600 milligrams, which requires two injections (300 milligrams each). You will likely receive your first dose at your health care provider’s office or clinic. After that, the typical dosage for BP is one injection (300 milligrams) given every two weeks. 

At first, Dupixent is usually used along with an oral steroid medicine (such as prednisone) to help bring your symptoms under control. Once symptoms improve, your health care provider may slowly lower the steroid dose. After that, Dupixent may be continued on its own. If symptoms come back, steroids may be added again if needed. Be sure to follow the instructions from your health care provider. 

Dupixent’s effectiveness for treating adults with bullous pemphigoid was tested in a clinical trial called ADEPT. To join the study, people had to have BP with the following symptoms:

  • Itchiness rated as an intensity of 4 or higher (on a scale of 0 to 10)
  • Skin blisters rated as a severity of 24 or higher (on a scale of 0 to 360)

Here is how the study was designed in order to test how well Dupixent worked for BP: 

  • In the 52-week trial, people were randomly chosen to receive either Dupixent or a placebo (a shot with no medicine). No one in the study knew which one they were getting. Everyone received injections every two weeks. 
  • Everyone in the study also started out taking oral steroids (such as prednisone) to help control symptoms. Once a person’s symptoms were stable for at least two weeks, their health care provider began to slowly lower (taper) the steroid dosage. The goal was to stop steroid use by week 16, as long as the skin stayed under control.
  • If a person’s symptoms came back (such as new blisters forming or old ones not healing), they were considered to have lost control of the disease. This counted as a “treatment failure” if it happened after stopping steroids or if the person needed extra medicines to get their symptoms under control.
  • During the tapering process, people were allowed to increase their steroid dose one time if needed (under the guidance of healthcare professionals). But if they needed more than one increase or required stronger treatments, it was considered rescue therapy. “Rescue treatments” could include more steroids, other immune-suppressing medications, or certain biologic drugs. If someone needed only rescue steroids (either taken by mouth or applied to the skin), they were allowed to continue participating in the trial.

The trial included 106 adults with BP. The average participant age was 71. Just over half (53%) of the participants were female. Around 68% were White, 15% were Asian, and 2% were Black or African American. A small percentage (3%) identified as Hispanic or Latino.

At the time of joining the study, the participants had an average itchiness score of 7.5 (on a scale of 0 to 10). Many of the participants (63%) had already tried steroid medicines in the past to treat their BP. 

The main goal of the study was to see if Dupixent could help people with BP get their symptoms under control and keep them from coming back, even after stopping steroids. Meeting this goal would show that the treatment could provide lasting relief without the need for additional medicines. Next, we’ll explain how this was measured in more detail and what the study results showed. 

To measure the effect of Dupixent for BP, the main goal (primary endpoint) of the ADEPT trial was to see how many people successfully reached sustained remission by week 36. To count as reaching sustained remission, three things had to happen:

  1. Complete remission and no steroids by week 16: The person’s blisters and other symptoms had to heal or clear up, and they had to stop taking oral steroids no later than week 16.
  2. No relapse after stopping steroids: From the time they stopped steroids through week 36, their symptoms had to stay under control. This means no new blisters or return of bad symptoms.
  3. No need for rescue treatment: They did not need any rescue medicines (like extra steroids or other treatments) to manage their BP during the 36-week treatment period.

The results of the ADEPT trial showed that Dupixent was more effective than a placebo for reaching sustained remission in adults with BP:

  • At week 36, about 18% of people in the Dupixent group reached sustained remission.
  • In comparison, only 6% of people in the placebo group reached the same goal.

Your results may be different from what was seen in studies.

Besides the main goal of keeping track of how many people experienced sustained remission, the researchers also looked at how many people experienced a noticeable improvement in itch and at how much steroid use was needed during the trial.

To measure the effect of Dupixent for BP on itchiness, one of the goals was to see how many people had at least a 4-point improvement on a symptom rating scale for itchiness. Throughout the study, people were asked to give a daily rating of how bad their itchiness felt on a scale of 0 to 10. This symptom rating scale is called the Peak Pruritus Numerical Rating Scale (NRS) and ranges from 0 (“no itch”) to 10 (“worst imaginable itch”). A 4-point drop is considered a meaningful improvement. 

In terms of these other benefits, the results of the Dupixent trial for BP showed that:

  • People taking Dupixent needed less steroid medicines over time. 
  • Itch improved by 4 points or more (on a scale of 0 to 10) in around 38% of people taking Dupixent, compared to about 11% taking the placebo. 
  • Fewer people in the Dupixent group needed rescue treatments during the study (53%) compared to those in the placebo group (79%).

Overall, these results suggest that Dupixent helped more people manage their bullous pemphigoid symptoms while using fewer steroids and needing less extra medicines. 

Keep in mind that individual results can vary. Talk with your health care provider if you have questions about what to expect from Dupixent treatment. 

The safety of Dupixent for BP was studied in a 52-week clinical trial. Dupixent has been FDA-approved for other uses since 2017 and has been used long-term to treat conditions such as eczema and asthma. 

Overall, in the clinical trial for BP, most people were able to stay on treatment. Some people (about 4% to 9%) had mild side effects, such as:

  • Joint pain
  • Red or itchy eyes
  • Blurry vision
  • Viral infections such as cold sores (herpes simplex) or shingles (herpes zoster)

Injection site reactions are possible and may include pain, swelling, or irritation where Dupixent is given. These reactions are usually mild and temporary, but your health care provider may recommend a cool compress to ease discomfort. 

One person with BP who used Dupixent in a clinical trial had a rare allergic reaction called acute generalized exanthematous pustulosis (AGEP). Tell your health care provider or get help right away if you notice any of the following symptoms of AGEP:

  • Tiny bumps (pustules) on your skin that may join together and start to peel off
  • Itching that feels different than usual
  • Burning sensation
  • Fever
  • Swollen lymph nodes

This is not a full list of Dupixent side effects. Other serious side effects are possible. Talk with your health care provider if you are having symptoms that bother you. If you experience anything that you think may be caused by Dupixent, you can also report side effects to the FDA at 800-FDA-1088 (800-332-1088).

A cost assistance program is available from Sanofi and Regeneron, the manufacturer of Dupixent. It may reduce the amount you pay. Whether you qualify to enroll may depend on what type of insurance you have or if you are uninsured. Visit this website from the drugmaker for more information about Dupixent costs and copay savings. 

 You can also contact the drugmaker at 844-387-4936 to connect with a representative for financial support information and other resources.