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

DISCUSSION

The evidence for dupilumab use beyond atopic dermatitis in dermatology is limited, without any current published randomized controlled trials supporting efficacy for additional indications. Retrospective reviews suggest it may be helpful for allergic contact dermatitis and hand dermatitis. Several other reports identify potential uses including alopecia areata and CSU. With small case series and case reports, it is possible that there is positive selection bias for description of successful off-label use of dupilumab in dermatology, and real-world data on off-label dupilumab use overall is lacking.

However, this is a promising new drug that may eventually be shown to have efficacy for various conditions in dermatology. Reasonable potential applications include diseases where Th2 responses are important to disease pathophysiology and where an appreciable proportion of patients fail to respond to current therapies, such as chronic urticaria.30 The case series of 6 patients with CSU who failed omalizumab but responded to dupilumab is highly interesting. If dupilumab is shown to be effective for CSU in the RCT currently in progress, many interesting questions follow. For example, CSU patients with low baseline serum total IgE levels tend to poorly respond to omalizumab, but whether response of chronic urticaria to dupilumab varies depending on baseline IgE levels remains to be answered.31

Dupilumab has a relatively safe side effect profile, and the increased rates of conjunctivitis seen with dupilumab use thus far have only been observed in patients with atopic dermatitis.32,33 Its potential for further applications in dermatology in recalcitrant cases is a highly interesting topic, although cost is a significant limiting factor. Ultimately, many further clinical studies, and increased understanding of skin disease pathophysiology will help determine the best possible uses for dupilumab in dermatology.

DISCLOSURES

The authors report no conflict of interest.

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AUTHOR CORRESPONDENCE

Nolan J. Maloney BS nmaloney@mednet.ucla.edu