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

Abstract

Dupilumab is the only available biological treatment for moderate-to-severe atopic dermatitis (AD). Even so, limited clinical data regarding its safety profile are available. Interactions with other drugs and the adverse effects of Dupilumab on patients with multiple comorbidities, such as chronic heart disease, diabetes, chronic kidney disease, etc., are not known yet. Moreover, there have been described cases of cutaneous lymphomas induced by Dupilumab. Therefore, the clinician that wants to start treatment for moderate-to-severe atopic dermatitis, which does not respond to conventional drugs, might be reluctant to choose biologic agents such as Dupilumab. In this paper, we reported a case of severe atopic dermatitis with multiple comorbidities in which the patient was successfully treated with Dupilumab despite numerous underlying conditions. We also conducted a review of the current literature on the safety profile of Dupilumab in special categories of patients with comorbidities, such as heart, kidney, and liver disease, oncologic conditions, and during pregnancy.

Exploring the Potential of IL-4 and IL-13 Plasma Levels as Biomarkers in Atopic Dermatitis

“…Although blocking this common receptor for the two ILs brings significant clinical benefits in atopic dermatitis, this benefit is not found for all pathologies in which IL-4 and IL-13 intervene, as a recent study suggests that IL-4/IL-13’s anti-inflammatory properties could be useful for inflammatory arthritis treatment [ 36 ]. Additionally, in one of our own studies regarding the use of Dupilumab for AD treatment, we found that the use of this drug can lead to the progression of myeloproliferative disorders in patients in which the underlying disease is misdiagnosed as AD [ 37 ]. As we showed in the current study, inhibition of the receptor for IL-4 and IL-13 leads to an increased serum concentration of both ILs.…”

Regression of metastatic malignant melanoma with dupilumab: A case report

“…9,10 Clinical trials for dupilumab did not include patients with cancer, and current immunosuppressive agents used for the treatment of AD raise safety concerns when being used for patients with malignancies with the possibility of exacerbation of cancer, although several recent reports have found no evidence linking dupilumab with cancer recurrence. [11][12][13] There are many components to the tumour microenvironment (TME) in epithelial cancers, including fibroblasts, immune and inflammatory cells, blood and lymph vessels, and nerves, all with the potential to influence tumour behaviour. Tumour-associated macrophages are particularly plentiful at all stages of tumour growth, and these have been shown to facilitate angiogenic responses and promote tumour proliferation.…”

“… 9 , 10 Clinical trials for dupilumab did not include patients with cancer, and current immunosuppressive agents used for the treatment of AD raise safety concerns when being used for patients with malignancies with the possibility of exacerbation of cancer, although several recent reports have found no evidence linking dupilumab with cancer recurrence. 11 , 12 , 13 …”

“…It is a humanised IgG4 antibody with key roles in Type 2 inflammatory responses triggered by allergens and mediated by T helper 2 (Th2) cells and blocks the structurally similar cytokines Interleukin‐4 (IL‐4) and IL‐13 to disrupt signalling through the type I and type II receptor complexes 9,10 . Clinical trials for dupilumab did not include patients with cancer, and current immunosuppressive agents used for the treatment of AD raise safety concerns when being used for patients with malignancies with the possibility of exacerbation of cancer, although several recent reports have found no evidence linking dupilumab with cancer recurrence 11–13 …”