Atopic Dermatitis Treated Safely with Dupilumab during Pregnancy: A Case Report and Review of the Literature

Abstract

Dupilumab is currently the only biologic treatment approved for moderate-to-severe atopic dermatitis. Though limited, available clinical data describing dupilumab use in pregnancy have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Systemic treatment in pregnant women with atopic dermatitis is currently restricted to corticosteroids, cyclosporine A, and azathioprine. Atopic dermatitis often has a deleterious course in pregnancy which can cause substantial distress and significantly impact on global health and quality of life. We report a case of severe atopic dermatitis treated safely with dupilumab during pregnancy with no adverse maternal or fetal outcomes observed. Our case highlights that dupilumab use in pregnancy has its place but should always be preceded by careful assessment of the risks and benefits. Clinicians are encouraged to enroll their patients in relevant pregnancy registry studies to monitor outcomes in women exposed to dupilumab during pregnancy and lactation.

Severe atopic dermatitis treated successfully with dupilumab throughout pregnancy

“…Kage et al 3 . published a case report describing dupilumab being used from month 3 of pregnancy, while Lobo et al 4 . detailed a patient who received dupilumab from conception until Week 24 of pregnancy, with recommencement post partum.…”

Pruritus in Pregnancy

“…Dupilumab inhibits signaling via IL-4 and IL-13 by inhibiting both IL-4 type 1 and 2 receptors on various immune cells [ 18 , 19 ]. Data regarding its safety profile in case reports are promising [ 20 , 21 ] but not yet sufficient. We recommend postponing the use of dupilumab in pregnancy until more experience and evidence becomes available.…”

“…The anti-IL-4R-α antibody dupilumab is considered an effective option in the treatment of refractory atopic dermatitis. To date, only two case reports of treatment with dupilumab in pregnancy with good fetus and pregnancy outcomes have been published [ 20 , 21 ]. We recommend postponing the use of dupilumab in pregnancy until more data regarding the safety profile are available.…”

Dupilumab therapy in atopic dermatitis is safe during COVID‐19 infection era: A systematic review and meta‐analysis of 1611 patients

“…Currently, the available data from case report studies indicate a favorable effect of dupilumab in terms of efficacy that was associated with wide safety margin towards maternal and fetal pregnancy outcomes. 4 , 5 , 6 Moreover, the treatment of the elderly group affected with AD is of paramount interest among the dermatologic society due to the challenging treatment‐induced side effects together with the anticipated reduction of the drug efficacy in this group of patients. In the multicenter study of Patruno and colleagues, elderly AD patients (>65 years old) allocated to receive dupilumab had a significant improvement of their condition.…”