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Dupilumab-Associated Arthritis: A Dermatology-Rheumatology Perspective

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Abstract

Dupilumab is an interleukin (IL)-4/13 inhibitor approved by the US FDA for multiple atopic indications. It is well-known to have favorable efficacy and safety profiles; however, emerging reports of dupilumab-associated arthritis suggest an underrecognized potential adverse effect. In this article, we summarize the literature to date to better characterize this clinical phenomenon. Arthritic symptoms were most commonly peripheral, generalized, and symmetric. Onset was generally within 4 months following initiation of dupilumab, and most patients resolved fully after a matter of weeks following discontinuation. Mechanistic insights suggest that suppression of IL-4 may lead to increased activity of IL-17, a prominent cytokine in inflammatory arthritis. We propose a treatment algorithm that stratifies patients by severity, recommending that patients with more mild disease continue dupilumab and treat through symptoms, while patients with more severe disease discontinue dupilumab and consider switching to another class (e.g., Janus kinase inhibitors). Lastly, we discuss important ongoing questions that should be addressed in future studies.

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Authors and Affiliations

  1. Department of Dermatology, Brigham and Women’s Hospital, 41 Avenue Louis Pasteur, 319, Boston, MA, 02115, USA

    Michael J. Woodbury, Jeffrey S. Smith & Joseph F. Merola

  2. Harvard Medical School, Boston, MA, USA

    Michael J. Woodbury, Jeffrey S. Smith & Joseph F. Merola

Authors
  1. Michael J. Woodbury
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  2. Jeffrey S. Smith
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  3. Joseph F. Merola
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Correspondence to Joseph F. Merola.

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No sources of funding were used to assist in the preparation of this work.

Conflicts of interest

Joseph F. Merola is a consultant and/or investigator for Merck, Abbvie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and Leo Pharma. Michael J. Woodbury and Jeffrey S. Smith have no conflicts of interest to disclose.

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Author contributions

Article conception and design: MJW, JSS, JFM. Data collection: MJW, JSS, JFM. Analysis and interpretation of results: MJW, JSS, JFM. Draft manuscript preparation: MJW, JSS. All authors read and approved the final manuscript.

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Woodbury, M.J., Smith, J.S. & Merola, J.F. Dupilumab-Associated Arthritis: A Dermatology-Rheumatology Perspective. Am J Clin Dermatol 24, 859–864 (2023). https://doi.org/10.1007/s40257-023-00804-5

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  • DOI: https://doi.org/10.1007/s40257-023-00804-5

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