The use of selective Th2 blocker dupilumab for the treatment of atopic dermatitis in a heart transplant patient: Case report

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by relapsing eczematous rash with severe pruritus and recurrent infection. Topical emollients and immune‐modulators (e.g., corticosteroids and calcineurin inhibitor) are first‐line therapies for acute flares. In severe refractory cases, systemic immunosuppression may be required. Increased incidence of AD has been documented in heart‐transplant children who receive their transplant or thymectomy before the age of 1 year. The treatment of these patients remains a conundrum for dermatologists. We present a case report of a chronically immunosuppressed transplant patient with severe AD treated with dupilumab and in remission for over 2 years with minimal side effects. We will also discuss impact of transplant immunosuppression in the pathogenesis of AD.

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

“…Dupilumab seems to be also safe for patients with heart transplants, as demonstrated in three case reports [ 7 , 8 , 9 ]. In the first case, a patient aged 18 with severe AD and a past medical history of left hypoplastic heart syndrome status post heart transplantation at 1 month of age, Crohn’s disease diagnosed in 2015 with no previous treatments, seasonal allergies, and asthma was initiated on Dupilumab with a loading dose of 600 mg subcutaneously followed by 300 mg every 2 weeks [ 7 ]. At the 2 years follow-up, AD remained well controlled with 300 mg of Dupilumab being administered every three weeks.…”

Practical Management of Patients with Atopic Dermatitis on Dupilumab

“…All cases reported significant effectiveness and safety for as long as 2 years with no new safety issues or concerning infections reported [64]. Notably, conjunctivitis was observed in two patients following dupilumab initiation and required artificial tears, periocular tacrolimus, and/or steroid drops [64,65].…”

“…There are several case reports of dupilumab use in patients experiencing AD following solid organ transplants including heart and liver [62][63][64][65]. All cases reported significant effectiveness and safety for as long as 2 years with no new safety issues or concerning infections reported [64].…”

“…There are several case reports of dupilumab use in patients experiencing AD following solid organ transplants including heart and liver [62][63][64][65]. All cases reported significant effectiveness and safety for as long as 2 years with no new safety issues or concerning infections reported [64]. Notably, conjunctivitis was observed in two patients following dupilumab initiation and required artificial tears, periocular tacrolimus, and/or steroid drops [64,65].…”

Dupilumab for the treatment of atopic dermatitis in transplant patients: Two case reports and literature review

“… 1 Its contraindications are very few, such as known hypersensitivity to dupilumab or any of the excipients. 2 Currently, there are sporadic reports of dupilumab use in solid organ transplant recipients 3 , 4 , 5 , 6 , 7 (Table 1 ). We report two transplant patients affected by AD and treated with dupilumab.…”