Transient adverse events associated with the use of dupilumab in a child with severe atopic dermatitis



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Abstract

Atopic dermatitis is a multifactorial inflammatory skin disease with genetic predisposition characterized by itching, chronic relapsing course, age-dependent localization and morphology of the lesions. In a situation where external therapy for moderate to severe atopic dermatitis does not have sufficient effect, patients are prescribed systemic therapy. Currently, dupilumab is the first line systemic therapy option for the treatment of moderate to severe atopic dermatitis. Along with its high effectiveness, a number of side effects have been described.

This article describes a clinical case of a patient with severe atopic dermatitis and food allergy, who started therapy with dupilumab. During the treatment, the patient experienced several subsequent adverse effects: conjunctivitis, herpes infection, eosinophilia.

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About the authors

Evgeniy E. Varlamov

The Russian National Research Medical University named after N.I. Pirogov

Author for correspondence.
Email: varlamov80@mail.ru
ORCID iD: 0000-0003-4295-725X
SPIN-code: 2698-6740

MD, Cand. Sci. (Medicine)

Россия, Moscow

Aleksandr N. Pampura

The Russian National Research Medical University named after N.I. Pirogov; Morozov Children’s City Clinical Hospital; Russian Medical Academy of Continuing Professional Education

Email: apampura1@mail.ru
ORCID iD: 0000-0001-5039-8473
SPIN-code: 9722-7961

MD, Dr. Sci. (Medicine), Professor

Россия, Moscow; Moscow; Moscow

References

  1. Атопический дерматит. Клинические рекомендации. Москва. 2024. Режим доступа: https://cr.minzdrav.gov.ru/view-cr/265_3
  2. Wollenberg A, Werfel T, Ring J, et al. Atopic dermatitis in children and adults — diagnosis and treatment. Dtsch Arztebl Int. 2023;120(13):224–234. doi: 10.3238/arztebl.m2023.0011 EDN: VAXHMU
  3. Noda S, Kreuger JG, Guttman-Yassky E. The translational revolution and use of biologics in patients with inflammatory skin diseases. J Allergy Clin Immunol. 2015;135(2):324–336. doi: 10.1016/j.jaci.2014.11.015 EDN: UOJYCP
  4. Brunner PM, Guttman-Yassky E, Leung DY. The immunology of atopic dermatitis and its reversibility with broad-spectrum and targeted therapies. J Allergy Clin Immunol. 2017;139(4S):S65–S76. doi: 10.1016/j.jaci.2017.01.011 EDN: ZABDXH
  5. Gandhi NA, Pirozzi G, Graham NMH. Commonality of the IL-4/IL-13 pathway in atopic diseases. Expert Rev Clin Immunol. 2017;13(5):425–437. doi: 10.1080/1744666X.2017.1298443 EDN: YVGHFA
  6. Hamilton JD, Suarez-Farinas M, Dhingra N, et al. Dupilumab improves the molecular signature in skin of patients with moderate-to-severe atopic dermatitis. J Allergy Clin Immunol. 2014;134(6):1293–1300. doi: 10.1016/j.jaci.2014.10.013
  7. Gooderham MJ, Hong HC, Eshtiaghi P, Papp KA. Dupilumab: a review of its use in the treatment of atopic dermatitis. J Am Acad Dermatol. 2018;78(3 Suppl 1):S28–S36. doi: 10.1016/j.jaad.2017.12.022 EDN: BSWBOE
  8. Seegräber M, Srour J, Walter A, et al. Dupilumab for treatment of atopic dermatitis. Expert Rev Clin Pharmacol. 2018;11(5):467–474. doi: 10.1080/17512433.2018.1449642 EDN: XCSHDM
  9. Beck LA, Bissonnette R, Deleuran M, et al. Dupilumab in adults with moderate to severe atopic dermatitis: a 5-year open-label extension study. JAMA Dermatol. 2024;160(8):805–812. doi: 10.1001/jamadermatol.2024.1536
  10. Beck LA, Deleuran M, Bissonnette R, et al. Dupilumab provides acceptable safety and sustained efficacy for up to 4 years in an open-label study of adults with moderate-to-severe atopic dermatitis. Am J Clin Dermatol. 2022;23(3):393–408. doi: 10.1007/s40257-022-00685-0 EDN: ADDOGO
  11. Kulthanan K, Tuchinda P, Nitiyarom R, et al. Clinical practice guidelines for the diagnosis and management of atopic dermatitis. Asian Pac J Allergy Immunol. 2021;39(3):145–155. doi: 10.12932/AP-010221-1050 EDN: LERDSO
  12. Chu DK, Schneider L, Asiniwasis RN, et al. Atopic dermatitis (eczema) guidelines: 2023 American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force on Practice Parameters GRADE and Institute of Medicine-based recommendations. Ann Allergy Asthma Immunol. 2024;132(3):274–312. doi: 10.1016/j.anai.2023.11.009 EDN: BHXLKE
  13. Ryser FS, Yalamanoglu A, Valaperti A, et al. Dupilumab-induced eosinophilia in patients with diffuse type 2 chronic rhinosinusitis. Allergy. 2023;78(10):2712–2723. doi: 10.1111/all.15844 EDN: YIZSNX
  14. Wechsler ME, Klion AD, Paggiaro P, et al. Effect of dupilumab on blood eosinophil counts in patients with asthma, chronic rhinosinusitis with nasal polyps, atopic dermatitis, or eosinophilic esophagitis. Allergy Clin Immunol Pract. 2022;10(10):2695–2709. doi: 10.1016/j.jaip.2022.05.019 EDN: WTAUNM
  15. Marcant P, Balayé P, Merhi R, et al. Dupilumab-associated hypereosinophilia in patients treated for moderate-to-severe atopic dermatitis. J Eur Acad Dermatol Venereol. 2021;35(6):e394–e396. doi: 10.1111/jdv.17177 EDN: KAHQSA
  16. Ahn J, Bae JY, Seo SJ. A retrospective case series hypereosinophilia during dupilumab treatment: hypereosinophilia could be a pharmacogenetic biomarker of dupilumab. Dermatol Ther. 2020;33(6):e13847. doi: 10.1111/dth.13847 EDN: GOPJBK
  17. Lommatzsch M, Stoll P, Winkler J, et al. Eosinophilic pleural effusion and stroke with cutaneous vasculitis: two cases of dupilumab-induced hypereosinophilia. Allergy. 2021;76(9):2920–2923. doi: 10.1111/all.14964 EDN: BCSAGG
  18. Descamps V, Deschamps L, El Khalifa J, et al. Eosinophilic vasculitis associated with persistent dupilumab-induced hypereosinophilia in severe asthma. Respir Med Res. 2021;79:100821. doi: 10.1016/j.resmer.2021.100821 EDN: EFFNWU
  19. Kurihara M, Masaki K, Matsuyama E, et al. How can dupilumab cause eosinophilic pneumonia? Biomolecules. 2022;12(12):1743. doi: 10.3390/biom12121743 EDN: XIYBCR
  20. Neagu N, Dianzani C, Avallone G, et al. Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review. J Eur Acad Dermatol Venereol. 2022;36(6):820–835. doi: 10.1111/jdv.17981 EDN: BRZCYB
  21. Akinlade B, Guttman-Yassky E, de Bruin-Weller M, et al. Conjunctivitis in dupilumab clinical trials. Br J Dermatol. 2019;181(3):459–473. doi: 10.1111/bjd.17869 EDN: RGJHSE
  22. Ou Z, Chen C, Chen A, et al. Adverse events of Dupilumab in adults with moderate-to-severe atopic dermatitis: a meta-analysis. Int Immunopharmacol. 2018;54:303–310. doi: 10.1016/j.intimp.2017.11.031 EDN: KIDKHS
  23. Jun I, Kim BR, Park SY, et al. Interleukin-4 stimulates lipogenesis in meibocytes by activating the STAT6/PPARg signaling pathway. Ocul Surf. 2020;18(4):575–582. doi: 10.1016/j.jtos.2020.04.015 EDN: JRQAUT
  24. García-Posadas L, Hodges RR, Diebold Y, Dartt DA. Context-dependent regulation of conjunctival goblet cell function by allergic mediators. Sci Rep. 2018;8(1):12162. doi: 10.1038/s41598-018-30002-x EDN: VRBQKZ
  25. Wang Y, Jorizzo JL. Retrospective analysis of adverse events with dupilumab reported to the United States Food and Drug Administration. J Am Acad Dermatol. 2021;84(4):1010–1014. doi: 10.1016/j.jaad.2020.11.042 EDN: GSNBCK
  26. Eichenfield LF, Bieber T, Beck LA, et al. Infections in dupilumab clinical trials in atopic dermatitis: a comprehensive pooled analysis. Am J Clin Dermatol. 2019;20(3):443–456. doi: 10.1007/s40257-019-00445-7 EDN: XCNSIK
  27. Paller AS, Siegfried EC, Simpson EL, et al. A phase 2, open-label study of single-dose dupilumab in children aged 6 months to <6 years with severe uncontrolled atopic dermatitis: pharmacokinetics, safety and efficacy. J Eur Acad Dermatol Venereol. 2021;35(2):464–475. doi: 10.1111/jdv.16928 EDN: ICFUKO
  28. Agache I, Akdis CA, Akdis M, et al. EAACI Biologicals Guidelines — dupilumab for children and adults with moderate-to-severe atopic dermatitis. Allergy. 2021;76(4):988–1009. doi: 10.1111/all.14690 EDN: ZMFKMH
  29. Rao M, Grove D, Haggstrom A. A rare presentation of herpes simplex virus encephalitis occurring in a pediatric patient on dupilumab for atopic dermatitis. Pediatr Dermatol. 2022;39(2):288–290. doi: 10.1111/pde.14970 EDN: EYBHDZ
  30. Narla S, Silverberg JI, Simpson EL. Management of inadequate response and adverse effects to dupilumab in atopic dermatitis. J Am Acad Dermatol. 2022;86(3):628–636. doi: 10.1016/j.jaad.2021.06.017 EDN: OYXWHZ
  31. Narantsatsral D, Junko T, Hideyuki I, et al. Painless thyroiditis in a dupilumab-treated patient. Endocrinol Diabetes Metab Case Rep. 2020;2020:20–0030. doi: 10.1530/EDM-20-0030 EDN: ECRHPM

Supplementary files

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2. Fig. 1. Atopic dermatitis complicated by microbial eczema in patient S.

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3. Fig. 2. Herpes infection which developed during dupilumab therapy.

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4. Fig. 3. Dynamics of clinical symptoms in patient S.

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