Xolair vs. Dupixent: Differences, similarities & side effects

In this article:

• Xolair vs. Dupixent: Key differences
• Xolair vs. Dupixent: Conditions treated
• Dupixent vs. Xolair: Which is better?
• Can you take Xolair and Dupixent together?
• Xolair vs. Dupixent: Insurance coverage and cost comparison
• Xolair vs. Dupixent side effects
• Xolair and Dupixent drug interactions
• Xolair and Dupixent drug warnings

In this article

• Xolair vs. Dupixent: Key differences
• Xolair vs. Dupixent: Conditions treated
• Dupixent vs. Xolair: Which is better?
• Can you take Xolair and Dupixent together?
• Xolair vs. Dupixent: Insurance coverage and cost comparison
• Xolair vs. Dupixent side effects
• Xolair and Dupixent drug interactions
• Xolair and Dupixent drug warnings

Xolair (omalizumab) and Dupixent (dupilumab) are two brand-name injectable medications indicated for treating asthma, among other inflammatory or autoimmune conditions. They are classified in a group of drugs called monoclonal antibodies, a type of biologic. 

“Biologics are complex medications that are typically made from DNA technology. Overall, biologics are an innovative treatment option for many rare or complex disease states,” said Christina Bookwalter, Pharm.D., a clinical pharmacist practitioner in Minneapolis, Minnesota.

In the case of Xolair and Dupixent, the biologics are antibodies, or protective proteins. They work by binding to the part of the immune system that causes allergic inflammation, said Jason M. Bellak, MD, an allergy/immunology physician and president of Allergy & Asthma Center in Las Vegas.

Though similar in some ways, Xolair and Dupixent have notable differences in their ingredients and approved uses.

Xolair vs. Dupixent: Key differences

Xolair and Dupixent are both brand-name biologic injections, but they work differently. The main difference is their mechanism of action or the specific biochemical reaction they trigger in the body.

“Xolair attaches to allergic antibodies called IgE antibodies, thereby decreasing allergic asthma, chronic hives, and food allergy reactions,” Dr. Bellak explained. “Dupixent is an antibody to what is called the interleukin 4 receptor alpha chain that is shared with interleukin 13. Interleukin 4 and 13 are key pro-allergic inflammatory chemicals. By blocking those chemicals, Dupixent decreases allergic inflammation.” 

Because they work somewhat differently, Xolair and Dupixent are also indicated for different types of asthma. 

Xolair vs. Dupixent: Comparing key differences
	Xolair	Dupixent
Drug class	Monoclonal antibody, biologic	Monoclonal antibody, biologic
Brand/generic status	Brand	Brand
What is the generic name?	omalizumab	dupilumab
What form(s) does the drug come in?	Auto-injector or pre-filled syringe or vial	Pen-injector or prefilled syringe
What is the standard dosage?	75–600 mg injection every 2 to 4 weeks depending on diagnosis	200–300 mg injection every other week depending on diagnosis
How long is the typical treatment?	Long-term	Long-term
Who typically uses the medication?	Adults, adolescents, and children ages 1 and older	Adults, adolescents, and children ages 6 months and older

Xolair vs. Dupixent: Conditions treated

When comparing Xolair versus Dupixent, it is also essential to know that they are approved to treat different but overlapping conditions. 

“They are both approved for the treatment of chronic sinusitis with nasal polyps in adults,” Dr. Bellak said. They’re also both approved for the treatment of moderate-severe asthma for people ages 6 and older, but Xolair is specifically approved to treat allergic asthma, while Dupixent is approved to treat severe eosinophilic asthma, which occurs when white blood cells called eosinophils cause airway inflammation.

Beyond that overlap, Xolair is approved by the Food and Drug Administration (FDA) to treat chronic spontaneous urticaria (CSU)—previously referred to as chronic idiopathic urticaria (CIU)—the medical term for hives with no cause. In 2024, the FDA also approved Xolair for accidental exposure in people with food allergies.

Dupixent, on the other hand, is FDA-approved for use in the treatment of eczema, medically known as atopic dermatitis (AD), eosinophilic esophagitis, and prurigo nodularis, a chronic skin disorder. 

In many cases, these biologics are only approved for severe cases of the above conditions or cases in which first-line treatments—such as an inhaler for asthma—have not effectively controlled symptoms.

Xolair vs. Dupixent: Comparing conditions treated
Condition	Xolair	Dupixent
Asthma	Yes	Yes
Chronic hives with no known cause	Yes	No
Food allergies	Yes	No
Chronic rhinosinusitis with nasal polyps	Yes	Yes
Eczema (atopic dermatitis)	No	Yes
Eosinophilic esophagitis	No	Yes
Prurigo nodularis	No	Yes

Dupixent vs. Xolair: Which is better?

Even in a head-to-head comparison of Xolair versus Dupixent, there is no clear winner. The two drugs are both effective, but they treat different conditions. 

• Placebo-controlled clinical trials funded by Sanofi, one of the manufacturers of Dupixent, show that Dupixent treatment in asthma patients ages 12 and older reduced severe exacerbations by 81% and improved overall asthma control and quality of life.
• A 16-year clinical trial follow-up of the effectiveness of Xolair (omalizumab) published in the Journal of Asthma and Allergy showed that Xolair is effective at reducing the incidence of severe asthma over the long term. Patient scores from baseline to follow-up significantly improved on the Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Test (ACT)—two standardized measurements of asthma symptom control. 

Ultimately, both Dupixent and Xolair have proven effective at improving symptoms of severe asthma. Dr. Bellak says determining the best medication for conditions treated by Dupixent and Xolair is complicated and requires a “global” evaluation by an allergist or immunology specialist. A prescribing doctor will consider the patient’s current medical condition, medical history, laboratory data, allergy test results, other medications that could interact with Xolair or Dupixent, and patient preferences.

Can you take Xolair and Dupixent together?

“Biologic medications have not been studied together, and there is no FDA indication to use more than one biologic medication in patients,” Dr. Bellak said. He adds that in rare cases, a healthcare provider may consider using Xolair and Dupixent together, but that would be a discussion between the doctor and patient. 

Xolair vs. Dupixent: Insurance coverage and cost comparison

Without insurance, the average retail price of Xolair is about $4,020 for two 1-milliliter (ml) syringes, and Dupixent costs around $5,150 for two 2 ml pens. The amounts would usually cover a one-month supply for asthma treatment. Medication prices vary by pharmacy and insurance plan. 

“Due to the high cost of these medications, insurance coverage is an important point to consider,” Dr. Bookwalter said. “Typically, these medications require a prior authorization from the doctor before they are covered by insurance.”

Blair Gingerich, Pharm.D., an ambulatory care pharmacist in northern Indiana, explains that insurance companies require information from the doctor to authorize payment because drugs like Xolair and Dupixent are expensive and reserved for very specific diseases. “If they aren’t covered, patients can discuss other options with their provider,” she added. “Often, there are manufacturer coupons that are available, but eligibility for coupon use varies.”

Cash payers can also save money on Xolair and Dupixent with a SingleCare prescription discount card. The card provides access to coupons at participating pharmacies that could reduce the cost of Xolair to about $2,730 and the cost of Dupixent to about $3,600.

Xolair vs. Dupixent: Comparing insurance & cost
	Xolair	Dupixent
Typically covered by insurance?	Depends on plan	Depends on plan
Typically covered by Medicare Part D?	Yes	Yes
Quantity	2, 1 ml pre-filled syringes	2, 2 ml pre-filled injector pens
SingleCare cost	$2,730	$3,600

 

Xolair vs. Dupixent side effects

Xolair and Dupixent are biologic injections but have different side effects. 

The most common side effects of Xolair are injection site reactions, joint stiffness, and body aches. The most common side effects of Dupixent are a reaction at the injection site and conjunctivitis, also known as pink eye.

Xolair’s drug label includes a disclaimer that an omalizumab injection may cause a serious or life-threatening allergic reaction. Seek help immediately if you have trouble breathing, break out in hives, or feel dizzy or faint after a Xolair injection. Other serious side effects of Xolair include cancer, inflammation of blood vessels, parasitic infection, heart problems, and a combination of fever, muscle aches, and rash. Report these uncommon but severe side effects to your doctor immediately.

Severe Dupixent side effects include an allergic reaction, eye problems, and joint pain so severe that it impedes mobility.

The following table lists side effects reported in at least 2% of clinical trial participants for Xolair or Dupixant. The adverse effect frequency listed on each drug’s label varies depending on the patient population in each study, and comparisons between the two drugs are imperfect without a head-to-head comparison study regarding side effects. Consult a healthcare professional for a complete list of side effects. 

Xolair vs. Dupixent: Comparing side effects
	Xolair		Dupixent
Side effect	Applicable?	Frequency	Applicable?	Frequency
Arthralgia (joint stiffness)	Yes	8%	Yes	3%
Body aches	Yes	7%	No	—
Leg pain	Yes	4%	No	—
Fatigue	Yes	3%	No	—
Dizziness	Yes	3%	Yes	3%
Fracture	Yes	2%	No	—
Arm pain	Yes	2%	No	—
Pruritus (itchy skin)	Yes	2%	No	—
Dermatitis (skin irritation or inflammation)	Yes	2%	No	—
Earache	Yes	2%	No	—
Injection site reaction	Yes	3%–45%	Yes	6%–38%
Conjunctivitis	No	—	Yes	10%
Oral herpes	No	—	Yes	4%
Other herpes simplex virus infection	No	—	Yes	2%

Source: Daily Med (Xolair) (Dupixent)

Xolair and Dupixent drug interactions

According to the drugs’ labels, there are no known adverse drug interactions between Xolair and other medications, nor for Dupixent and other medications. However, it is still essential to give your healthcare provider a list of all the medicines and supplements you take before starting one of these injections.

As a general rule, taking more than one biologic therapy at the same time is not recommended. That includes live vaccines such as MMR, varicella, rotavirus, and the intranasal flu vaccine. Other biologic therapies for severe eosinophilic asthma or severe allergic asthma include Nucala (mepolizumab) and Fasenra (benralizumab).

RELATED: Important information about Dupixent and vaccines

It’s very important to keep taking your other prescription medications while on Xolair or Dupixent. Though these are FDA-approved asthma treatments, they are not a substitute for a steroid inhaler, also called a corticosteroid inhaler. These injections are long-acting and do not provide emergency relief for poor lung function.

Xolair and Dupixent drug warnings

Xolair and Dupixent are not the right medications for everyone. It is important to weigh the risks against the benefits and seek medical advice from a healthcare provider who understands your medical conditions and history.

Because malignancy has been observed in clinical studies, Xolair may not be recommended for patients with cancer or a history of cancer. It may also not be recommended for patients with eosinophilia, vasculitic rash, or heart problems. The needle cap on Xolair’s prefilled syringe is latex, so this medication may not be recommended to people with latex allergies. And, of course, it is not safe for anyone allergic to omalizumab, the active ingredient in Xolair.

Dupixent does not have the warning for anaphylaxis that Xolair does. However, Dupixent may still cause serious side effects, including eye problems. It may not be recommended for patients with chronic eye issues or herpes virus infections. 

Finally, both Xolair and Dupixent have a statement on the label to tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding.