Abstract
Dupilumab has emerged as an effective treatment option for those suffering from moderate-to-severe atopic dermatitis (AD). Since its approval in 2017 by the United States Food and Drug Administration, dupilumab demonstrated efficacy in a wide range of “off-label” dermatologic conditions. With its increasing use, dermatologists must navigate prescribing dupilumab in complex patient populations. To that end, we performed a single-institution, retrospective, case-series study to assess efficacy, tolerability, and safety of dupilumab in elderly, patients on concomitant immunosuppressive/immunomodulating therapies, and those with pre-existing co-morbidities (e.g., malignancies, chronic renal and/or liver diseases, organ transplantation, hematologic malignancies, and infection). We conducted chart reviews of 248 patients who were prescribed dupilumab between January 1, 2017 and August 31, 2021, and identified 64 patients who met the criteria of being in the complex patient group as described above. Our results showed that 87.5% (56/64) of complex patients demonstrated improvement and/or disease clearance on dupilumab. 20.3% (13/64) of them experienced one or more side effects reported as conjunctivitis, seborrheic dermatitis, psoriasiform eruption, xerosis, facial burning sensation, anaphylactic reaction/angioedema, and worsening of AD. 9.4% (6/64) of them discontinued dupilumab due to the side effects. These findings demonstrated that dupilumab can be safely considered in certain complex patient populations such as elderly and those with significant pre-existing co-morbidities and can be safely combined with immunosuppressive medications and/or other biologic therapies. In the future, more studies with long-term follow-up are needed to validate the efficacy and safety of dupilumab in these challenging patients with complex medical histories.
References
Hendricks AJ, Yosipovitch G, Shi VY (2021) Dupilumab use in dermatologic conditions beyond atopic dermatitis - a systematic review. J Dermatol Treat 32(1):19–28. https://doi.org/10.1080/09546634.2019.1689227
Siliquini N, Giura MT, Viola R et al (2021) Atopic dermatitis, dupilumab and cancers: a case series. J Eur Acad Dermatol Venereol 35(10):e651–e652. https://doi.org/10.1111/jdv.17264
Patruno C, Napolitano M, Argenziano G et al (2021) Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real-life study. J Eur Acad Dermatol Venereol 35(4):958–964. https://doi.org/10.1111/jdv.17094
Ly K, Smith MP, Thibodeaux Q, Beck K, Bhutani T, Liao W (2019) Dupilumab in patients with chronic hepatitis B on concomitant entecavir. JAAD Case Rep 5(7):624–626. https://doi.org/10.1016/j.jdcr.2019.05.007
Acknowledgement
We thank our BIDMC Dermatology Pharmacy Team for providing support in initial search of our database.
Funding
There was no funding for this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
DL and KP do not have any conflict of interest to report; JSM has an investigator-initiated dupilumab study that is funded by Regeneron Pharmaceuticals, Inc.
IRB statement
This study was determined to be exempt by the Beth Israel Deaconess Medical Center Institutional Review Board.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Lukac, D., Pagani, K. & McGee, J.S. Overview of use, efficacy, and safety of dupilumab in complex patients: a retrospective, case-series study from a large, urban academic center. Arch Dermatol Res 315, 1777–1781 (2023). https://doi.org/10.1007/s00403-022-02362-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00403-022-02362-y