Relapsing-remitting multiple sclerosis arising in a patient with atopic dermatitis on dupilumab

Dupilumab in patients with moderate to severe atopic dermatitis and multiple sclerosis

“…An additional critical issue is the potential Th2 suppression with secondary dysregulation of Th1/17 in patients with MS. Recently, a temporal association was observed between flare-up of relapsing-remitting MS and treatment with dupilumab in an AD patient, who had a long-term untreated MS. 16 In this regard, the authors hypothesized that dupilumab's inhibition of the effects of IL-4 downstream actions may have altered the patient's cytokine milieu, shifting the balance of Th profiles in favor of Th1/17 pathways, which is, the T-cell phenotype thought to drive MS pathogenesis. 16 However, it is frequent that in young women the MS disease course is characterized by incoming, relapsing, and unstable episodes of multiple disease localization, especially if not treated, thus the clear attribution of a causal link seems undue.…”

Morphea after initiation of dupilumab in two pediatric atopic dermatitis patients

“…To our knowledge, there has only been one other report of morphea following dupilumab initiation, and this occurred in an adult 6 . While only three cases of morphea following blockade of Th2 signaling have now been described, numerous case reports of Th1‐ or Th17‐mediated inflammatory disorders have been reported to occur after initiation of dupilumab, including psoriasiform dermatitis, 10 pyoderma gangrenosum, 11 and multiple sclerosis 12 . These findings suggest that blockade of IL‐4Rα signaling for the treatment of atopic dermatitis may, in rare cases, inadvertently lead to the development of morphea through dysregulation of Th1/Th2 signaling.…”

Onset of multiple sclerosis in a patient on dupilumab therapy for atopic dermatitis: A case report

“…This case is the second reporting the onset of MS after initiation of dupilumab: Laageide et al described the onset of similar symptoms just 2 months after initiation of dupilumab. 7 …”

“…This case is the second reporting the onset of MS after initiation of dupilumab: Laageide et al described the onset of similar symptoms just 2 months after initiation of dupilumab. 7 Further studies are needed to better understand if dupilumab can increase the risk of MS onset or flareups. Meanwhile we recommend caution in prescribing dupilumab in patients with MS or a family history of MS.…”