Researchers have found that the use of dupilumab, a human monoclonal antibody targeting the IL-4 alpha receptor, is associated with an increased risk of cutaneous T cell lymphoma (CTCL) in patients with moderate to severe atopic dermatitis (AD), according to a study published in the Journal of the American Academy of Dermatology. The study was conducted by Iraj H. and colleagues.

Dupilumab is a commonly prescribed medication for the treatment of moderate to severe atopic dermatitis. It works by targeting the IL-4 alpha receptor, which plays a role in the inflammatory processes associated with the condition. While dupilumab has proven effective for many patients, there have been concerns about its long-term safety, particularly regarding its potential association with cutaneous T cell lymphoma (CTCL).

To investigate the potential link between dupilumab use and the risk of CTCL, researchers used the TrinetX database to compare the incidence of cutaneous and lymphoid malignancies, including CTCL, between a cohort of patients with AD who used dupilumab and a cohort who never used the medication. A secondary analysis was performed excluding patients with prior disease-modifying antirheumatic drug (DMARD) use. Propensity score matching was used to control for potential confounding variables.
The key findings of the study were:
• An increased risk of CTCL was observed in the cohort of AD patients who used dupilumab, with an odds ratio (OR) of 4.1003 (95% CI, 2.055-8.192).
• The increased risk persisted even after excluding patients with prior DMARD use.
• Among other cutaneous and lymphoid malignancies, no increased risk was found.
• Most of the CTCL cases (27 out of 41) were diagnosed more than one year after the initiation of dupilumab use.
The findings suggest that patients with AD who use dupilumab may have an increased risk of developing CTCL. However, it is important to note that this association does not prove causality. Further research is needed to better understand the potential link between dupilumab use and the development of CTCL, as well as to evaluate the long-term safety of the medication.
The study has several limitations, including potential misclassification within the database and the inability to assess the severity of atopic dermatitis in the patients. As a result, caution should be exercised when interpreting the findings.
In conclusion, the use of dupilumab in patients with atopic dermatitis was associated with an increased risk of cutaneous T cell lymphoma in this cohort study. Although the results indicate a potential safety concern, further research is needed to establish causality and determine the implications for clinical practice.
Reference:
Hasan, I., Parsons, L., Duran, S., & Zinn, Z. (2024). Dupilumab therapy for atopic dermatitis is associated with increased risk of cutaneous T cell lymphoma: a retrospective cohort study. Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2024.03.039