If you or your child have moderate to severe eczema, your dermatologist might prescribe dupilumab (Dupixent) for your treatment. This medication is different from other eczema treatments because you have to inject it subcutaneously (under your skin).

Two kinds of devices are available for injecting dupilumab — a pre-filled syringe and a pre-filled pen. This article will help you understand the difference between these two devices so you and your doctor can make an informed decision about which treatment option is right for you.

What Is Dupixent?

Dupixent is a prescription eczema treatment. Dupixent is the brand name for a medication called dupilumab. The U.S. Food and Drug Administration (FDA) has approved dupilumab to treat moderate to severe atopic dermatitis (a severe, chronic form of eczema) in adults and children 6 months and older.

Dupilumab is also FDA-approved to treat other conditions, including:

• Asthma, a lung disease
• Chronic rhinosinusitis with nasal polyps, inflammation of membranes within the sinuses with soft growths inside the nose
• Eosinophilic esophagitis, an allergic condition in the esophagus
• Prurigo nodularis, a skin condition that causes itchy bumps on the skin

Dupilumab is a biologic drug that’s manufactured using human-made proteins called antibodies. It works by blocking specific parts of the immune system to prevent inflammation that can make eczema worse. Because dupilumab is made of proteins, it must be given by subcutaneous injection. If you take it by mouth, your digestive system will break it down before it has a chance to work.

The manufacturer makes two types of devices to inject dupilumab — a pre-filled syringe and a pre-filled pen.

What Is a Pre-Filled Syringe?

A pre-filled syringe is a syringe that has been manufactured to contain a single dose of medication. This allows you or your health care provider to administer a dose of medication without worrying about measuring the right amount first.

When you use a pre-filled syringe, you’re in control of pushing the plunger down to inject the medication.

What Is a Pre-Filled Pen?

Like the pre-filled syringe, a pre-filled pen comes filled with a single dose of medication. The device will inject the medication for you at a controlled rate after you activate it. You don’t have to press a plunger the whole time when you use a pen device.

What’s the Difference?

If your doctor prescribes dupilumab, you may wonder what the differences are between the syringe and the pen.

The pre-filled syringe and the pre-filled pen deliver the same medication. The medication will work the same way and be just as effective regardless of whether you use the syringe or pen. However, who can use each device and how each one is used is slightly different.

Doses Available

Pre-filled syringes are available in doses of 100 milligrams, 200 milligrams, and 300 milligrams.

Pre-filled pens are available in 200-milligram and 300-milligram doses.

The usual dose for adults is 300 milligrams every other week. When you first start the medication, however, you’ll receive a larger dose — known as a loading dose — of 600 milligrams. This will be given as two 300-milligram injections.

The dose for children aged 6 months to 17 years is based on their weight and age. For children with atopic dermatitis, doses can range from 200 milligrams to 600 milligrams every two to four weeks. The 100-milligram pre-filled syringe is reserved for treating asthma in children ages 6 to 12 years old who weigh less than 30 kilograms (around 66 pounds).

Approved Age

The pre-filled syringe is FDA-approved for people 6 months and older.

The pre-filled pen is FDA-approved for people 2 and up.

Children under the age of 12 should have a parent or caregiver administer their injection. Once a child turns 12, they can learn to administer it themselves, if they wish, under the supervision of an adult.

Needle Visibility

When you use the pre-filled syringe, the needle is visible before the injection. After the injection, the needle will automatically be covered with a needle shield to protect you from accidental needle sticks.

The pre-filled pen has a needle cover, so you don’t see the needle before you inject. You’ll place this needle cover against your skin at the injection site when you are ready to activate the dose.

Instructions for Use

Your doctor will teach you how to inject dupilumab before you start doing it yourself. Although your preparation is similar for both types of devices, there are some key differences in the way you inject them.

Following are the manufacturer’s recommended steps for using a pre-filled syringe:

1. Wash your hands with soap and water.
2. Choose your injection location, which could be your thigh or your stomach — though avoid the 2-inch area around your bellybutton. A caregiver also may inject the medication into the outer portion of an upper arm.
3. Use an alcohol wipe to clean the injection site, then give it time to dry.
4. Carefully remove the need cap with the needle pointing away from you.
5. Pinch a fold of skin at the injection site.
6. Insert the needle into your skin at a 45-degree angle.
7. Ease up on the pinch as you slowly press the plunger as far as it goes to inject all of the medication.
8. Release the plunger until the needle shield will cover the needle, at which point you can remove it.

For a pre-filled pen, the company recommends the following:

1. Wash your hands with soap and water.
2. Choose your injection location, which could be your thigh or your stomach — though avoid the 2-inch area around your bellybutton. A caregiver also may inject the medication into the outer portion of an upper arm.
3. Use an alcohol wipe to clean the injection site, then give it time to dry.
4. Pull off the cap when you’re ready to make the injection.
5. If the person receiving the injection is 12 or under, pinch the skin of the injection site before and during the injection.
6. Place the needle cover onto the injection site at a 90-degree angle to your skin.
7. To inject the medication, press and hold the pen firmly into your skin until you can’t see the needle cover. You’ll know the injection has started when you hear a click.
8. Continue pressing for a count of five. You should hear another click to signal the injection is complete. Be sure to wait until all of the medication has been injected (or the window to turn completely yellow) before pulling away the pre-filled pen.

Ease of Use

The pre-filled pen may be easier to use for some people. In a 2023 study, researchers found that compared to the dupilumab pre-filled syringe, the pre-filled pen was easier to use and led to higher satisfaction.

Researchers have found that pre-filled pens with medications for other conditions are easier to use as well. A 2020 study of people taking subcutaneous methotrexate to treat juvenile idiopathic arthritis (a condition that causes joint inflammation) found that most caregivers and children preferred a pre-filled pen over a pre-filled syringe.

Tips for Using Dupilumab

Giving yourself or your child an injectable medication may take some significant adjusting. You shouldn’t self-inject dupilumab without being trained by a health care provider first. MyEczemaTeam members have learned how to give themselves dupilumab injections, “I’m on Dupixent and learning how to give my own injection as well, so let’s see how that goes,” shared one member.

Other members have complained that dupilumab injections can sometimes be painful. One said, “I just did my Dupixent injection, and, as usual, it hurt. I’m wondering if anyone has tips or tricks to make the injection less painful.”

Another member shared, “Got my first Dupixent injections!! They burn, but hopefully, it will help!!”

Although using a pre-filled pen might be easier, some people may find it more painful. However, studies with other medications for different conditions have found that pre-filled pens can make injections less painful. If you’re concerned about the pain associated with a dupilumab injection, talk to your doctor about the best treatment option for you.

To help make your injection less painful, you can try the following tips:

• Warm your medication to room temperature before injecting.
• Allow the alcohol used to clean your injection site to dry completely before injecting.
• Rotate among injection sites.
• Enlist the help of family and friends for support.

Talk With Others Who Understand

On MyEczemaTeam — the social network for people with eczema and their loved ones — more than 49,000 members come together to ask questions, give advice, and share their stories with others who understand life with eczema.

Do you use Dupixent? Do you use the pre-filled syringe or the pre-filled pen? Share your experience in the comments below, or start a conversation by posting on your Activities page.