Dupilumab in Dermatology: Potential for Uses Beyond Atopic Dermatitis
October 2019 | Volume 18 | Issue 10 | Features | 1053 | Copyright © October 2019
Nolan J. Maloney BS,ª Kyle Tegtmeyer BS,B Jeffrey Zhao BA,B Scott Worswick MDc
ªDavid Geffen School of Medicine at UCLA, Los Angeles, CA
bNorthwestern University Feinberg School of Medicine, Chicago, IL
cDepartment of Dermatology, Keck School of Medicine at USC, Los Angeles, CA
Dupilumab inhibits the interleukin-4 receptor subunit α and is FDA approved for treatment of moderate-to-severe atopic dermatitis. It is a relatively new drug, and whether it is efficacious for other diseases in dermatology is an area of increasing interest. We searched the literature and ClinicalTrials.gov database for uses of dupilumab beyond atopic dermatitis in dermatology and for ongoing studies on new uses for dupilumab. Off-label reports identified described use of dupilumab for several different dermatologic conditions, including allergic contact dermatitis, hand dermatitis, chronic spontaneous urticaria, prurigo nodularis, and alopecia areata. Overall, there is limited but promising data for dupilumab use beyond atopic dermatitis in dermatology. The relatively safe adverse effect profile of dupilumab may make it an option for certain recalcitrant diseases in dermatology, but further studies will be needed to assess its efficacy and determine its best possible use.
J Drugs Dermatol. 2019;18(10):1053-1055.
Dupilumab is an inhibitor of the interleukin (IL)-4 receptor subunit α (IL-4Rα), which prevents interaction of the T-helper 2 (Th2) cytokines IL-4 and IL-13 with their respective receptors. Its efficacy has been studied most in atopic dermatitis and asthma—diseases where Th2 type immune responses play central roles. It is the first biologic to receive FDA approval for atopic dermatitis. In general, dupilumab is well tolerated, with few serious adverse effects reported. Adverse effects can include nasopharyngitis, headache, conjunctivitis and injection-site reactions. In multiple clinical trials, patients on dupilumab had fewer skin infections compared to patients on placebo.1–3 Other reported possible adverse events included a relationship between dupilumab administration and development of alcohol flushing in one case, transient skin erythema and peeling, and alopecia.4–6 Given that dupilumab is relatively well tolerated and has shown efficacy in diseases mediated by Th2 processes, a new topic of interest is whether dupilumab might prove effective in other conditions in dermatology.
MATERIALS AND METHODS
The PubMED/MEDLINE database was queried with the term “dupilumab.” We screened individual abstracts to determine if there was use of dupilumab for a condition in dermatology besides atopic dermatitis. If unclear from the abstract, we screened the article text. Articles were required to be in English. We also queried the ClinicalTrials.gov database to search for ongoing studies of dupilumab in dermatology. Dupilumab dosing followed the standard regimen used for atopic dermatitis (600 mg loading dose, followed by 300 mg every 2 weeks) unless otherwise specified.
Allergic Contact Dermatitis
In retrospective reviews of patients with allergic contact dermatitis treated with dupilumab, most achieved improvements in involved body surface area (BSA), decreases in investiga