Overview of use, efficacy, and safety of dupilumab in complex patients: a retrospective, case-series study from a large, urban academic center

Lukac, Danitza; Pagani, Kyla; McGee, Jean S.

doi:10.1007/s00403-022-02362-y

Cited by 8 publications

(7 citation statements)

References 4 publications

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“…In adults, dupilumab can induce eruptions of psoriasiform dermatitis in transplant populations taking immunosuppressive agents. 9 This indicates that, despite overall decreased levels of cytokines and helper T cells in immunosuppressed individuals, the self-regulation and balance of the immune system is still critical to avoid adverse immunologic reactions. By themselves, tacrolimus and azathioprine can be used to treat dermatologic immune conditions, and yet when combined with selective immunomodulators like dupilumab, the balance of the immune system can be disrupted in such a way that predisposes toward immune-mediated reactions including psoriasiform dermatitis.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 Psoriasiform dermatitis following dupilumab therapy has previously been reported in children, adults, and adults with organ transplantation on immunosuppressive therapy. [7][8][9] Pediatric patients with dupilumab-induced psoriasiform dermatitis tend to have less severe and less refractory disease compared to adults, with many able to continue dupilumab long-term and manage their psoriasiform lesions with topical agents alone. 7 This report presents a paradoxically immune-mediated reaction in immunosuppressed children and reviews the literature surrounding the possible pathogenesis of this unexpected phenomenon.…”

Section: Introductionmentioning

confidence: 99%

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Dupilumab‐induced psoriasiform dermatitis in two pediatric cardiac transplant patients

Lockard,

Mullen,

Lee

et al. 2023

Pediatric Dermatology

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Dupilumab is an interleukin‐4 receptor antagonist important in the treatment of refractory atopic dermatitis (AD), particularly among pediatric patients. Two boys with a history of AD and cardiac transplant who developed psoriasiform dermatitis in response to dupilumab therapy are reported. These patients paradoxically developed an immune‐mediated adverse drug reaction despite taking systemic immunosuppressive agents. While the literature suggests possible pathomechanisms for psoriasiform dermatitis despite immunosuppression, further research is necessary to better characterize this unique and unexpected phenomenon.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Dupilumab‐induced psoriasiform dermatitis in two pediatric cardiac transplant patients

Lockard,

Mullen,

Lee

et al. 2023

Pediatric Dermatology

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“…Our results are mostly consistent with those from other reviews regarding the safety of Dupilumab administration for patients with pre-existing comorbidities. Lukac et al reported that 9.4% (6 out of 64 patients) discontinued Dupilumab due to severe side effects [ 43 ]. Other studies also concluded that there were no significant differences between patients with comorbidities and patients suffering only from AD as regards to the effectiveness and safety of Dupilumab [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Atopic Dermatitis with Multiple Comorbidities Treated with Dupilumab. A Case Report and Review of the Literature Regarding the Safety of Dupilumab

Mitroi

Stoica

Mitroi

et al. 2022

Life

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Dupilumab is the only available biological treatment for moderate-to-severe atopic dermatitis (AD). Even so, limited clinical data regarding its safety profile are available. Interactions with other drugs and the adverse effects of Dupilumab on patients with multiple comorbidities, such as chronic heart disease, diabetes, chronic kidney disease, etc., are not known yet. Moreover, there have been described cases of cutaneous lymphomas induced by Dupilumab. Therefore, the clinician that wants to start treatment for moderate-to-severe atopic dermatitis, which does not respond to conventional drugs, might be reluctant to choose biologic agents such as Dupilumab. In this paper, we reported a case of severe atopic dermatitis with multiple comorbidities in which the patient was successfully treated with Dupilumab despite numerous underlying conditions. We also conducted a review of the current literature on the safety profile of Dupilumab in special categories of patients with comorbidities, such as heart, kidney, and liver disease, oncologic conditions, and during pregnancy.

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“…Al-Janabi et al 2020 [87], Lukac et al 2022 [88] biologics for other conditions. In a randomized, placebo-controlled phase 2 trial of ixekizumab in chronic plaque psoriasis, one patient reported several paradoxical HS exacerbations after treatment [8].…”

Section: Il-4ramentioning

confidence: 99%

“…In both patients, there was no history of psoriasis or previous SD, and both patients were treated successfully with traditional SD therapies with resolution of symptoms [ 87 ]. In another series of 64 patients treated with dupilumab, one patient was noted to have SD eruptions due to treatment with biologic medication [ 88 ].…”

Section: Seborrheic Dermatitismentioning

confidence: 99%

Novel and Off-Label Biologic Use in the Management of Hidradenitis Suppurativa, Pyoderma Gangrenosum, Lichen Planus, and Seborrheic Dermatitis: A Narrative Review

Mital

Gray

Minta

et al. 2022

Dermatol Ther (Heidelb)

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With advances in drug development and our understanding of the pathophysiology of skin disease, biologic medications have emerged as powerful management tools for dermatologists. While biologics have most often been used in the management of psoriasis, they are being used off-label for the management of a variety of other immune-mediated skin diseases with overlapping molecular targets. This narrative review focuses on the novel and off-label use of biologic medications for the management of hidradenitis suppurativa (HS), pyoderma gangrenosum (PG), lichen planus (LP), and seborrheic dermatitis (SD). Review of the literature revealed that IL-17, IL-23, and tumor necrosis factor (TNF) inhibitors were being used across a variety of immune-mediated skin pathologies with variable efficacy, among other targeted biologics. While biologics were generally safe in the treatment of primary immune-mediated skin disorders, paradoxical disease eruptions were noted with biologic use and were theorized to occur owing to immune dysregulation and cytokine imbalance. While numerous case reports show promise for the use of biologics in immune-mediated skin pathologies, the variable efficacy and safety reported warrants more thorough investigations of the role of these targeted medications in comprehensive disease management.

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Overview of use, efficacy, and safety of dupilumab in complex patients: a retrospective, case-series study from a large, urban academic center

Cited by 8 publications

References 4 publications

Dupilumab‐induced psoriasiform dermatitis in two pediatric cardiac transplant patients

Dupilumab‐induced psoriasiform dermatitis in two pediatric cardiac transplant patients

Atopic Dermatitis with Multiple Comorbidities Treated with Dupilumab. A Case Report and Review of the Literature Regarding the Safety of Dupilumab

Novel and Off-Label Biologic Use in the Management of Hidradenitis Suppurativa, Pyoderma Gangrenosum, Lichen Planus, and Seborrheic Dermatitis: A Narrative Review

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