Dupilumab therapy for atopic dermatitis is associated with increased risk of cutaneous T cell lymphoma: a retrospective cohort study

Abstract:

Background

Dupilumab, a human monoclonal antibody targeting the IL4 alpha receptor, is used for treatment of moderate to severe atopic dermatitis (AD). Previous studies have reported diagnoses of cutaneous T cell lymphoma (CTCL) after dupilumab use.

Objective

Investigate the risk of CTCL after dupilumab use in patients with AD.

Methods

Using the TrinetX database, incidence of cutaneous and lymphoid malignancies including CTCL was compared between a cohort of patients with AD who used dupilumab and a cohort of patients with AD who never used dupilumab. A second analysis excluding prior DMARD use was performed. Propensity score matching was performed to control for covariates.

Results

An increased risk of CTCL was found in the cohort of AD patients who used dupilumab (OR 4.1003, 95% CI 2.055-8.192). The increased risk persisted after exclusion of prior DMARD use. Risk was not increased for other cutaneous or lymphoid malignancies. Most (27/41) cases of CTCL were diagnosed more than one year after dupilumab use.

Limitations

There is potential for misclassification in the database. Severity of atopic dermatitis could not be assessed. Association between dupilumab and CTCL does not prove causality.

Conclusion

Dupilumab use is associated with an increased risk of CTCL in patients with AD in this cohort.