Dupilumab treatment for atopic dermatitis linked to cutaneous T-cell lymphoma development

Key takeaways:

• Dupilumab-treated patients with AD were 4.1003 times more likely to develop cutaneous T-cell lymphoma vs. those who were not dupilumab-treated.
• Most cases were diagnosed more than 1 year after dupilumab use.

A new study finds that dupilumab is associated with an increased risk for cutaneous T-cell lymphoma in patients taking the drug for atopic dermatitis.

“Dupilumab, a human monoclonal antibody targeting [interleukin]-4 alpha receptor, is used for the treatment of moderate to severe [AD],” Iraj Hasan, BA, a student at the West Virginia University School of Medicine, and colleagues wrote. “However, there have been sporadic reports linking dupilumab use with cutaneous T-cell lymphoma, suggesting a potential association between dupilumab and the exacerbation of preexisting cutaneous T-cell lymphoma or an increased susceptibility to its development.”

Using the TrinetX database, the researchers collected data from 60 health care organizations comprising 22,888 patients with AD who used dupilumab and 1,115,235 patients with AD did not use dupilumab to analyze this potential association.

Results showed that patients with AD who were vs. were not treated with dupilumab had an increased risk for developing cutaneous T-cell lymphoma (OR = 4.1003; 95% CI, 2.055-8.192).

Even after excluding patients that previously used disease-modifying antirheumatic drugs, the increased risk for developing cutaneous T-cell lymphoma persisted.

Also, 27 out of the 41 cases of cutaneous T-cell lymphoma were diagnosed more than 1 year after dupilumab use; however, some cases occurred within the first 6 months (n = 9), suggesting that dupilumab may “unmask” cutaneous T-cell lymphoma in some patients.

On the other hand, dupilumab treatment decreased patients’ risks for developing basal cell carcinoma (OR = 0.398; 95% CI, 0.214-0.74) and melanoma (OR = 0.498; 95% CI, 0.256-0.969). The authors called this an incidental finding that calls for further study.

“These findings add further evidence to an association between dupilumab use and [cutaneous T-cell lymphoma],” the authors wrote, emphasizing that this underscores “the need for a high index of suspicion for development of cutaneous T-cell lymphoma following dupilumab use.”