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Th2 IL-4/IL-13 dual blockade with Dupilumab is linked to some Emergent Th17 type Diseases including seronegative arthritis, enthesitis/enthesopathy, but not humoral autoimmune diseases

Dupilumab, an IL-4/IL-13 receptor blocker, has been linked to emergent seronegative inflammatory arthritis and psoriasis that form part of the spondyloarthropathy (SpA) spectrum. We systematically investigated patterns of immune disorders including predominantly Th17- (SpA pattern), Th2-mediated disorders and humoral autoimmune pattern diseases, using VigiBase, the World Health Organization's (WHO) global pharmacovigilance of adverse drug reactions (ADRs). Several bioinformatics databases and repositories were mined to couple Dupilumab-related immune-pharmacovigilance with molecular cascades relevant to reported findings. 37,848 Dupilumab ADR cases were reported, with skin, eye, musculoskeletal systems most affected. Seronegative arthritis (OR 9.61) psoriasis (OR 1.48), enthesitis/enthesopathy (OR 12.65), and iridocyclitis (OR 3.77) were highly associated. However, Ankylosing Spondylitis and IBD were not conclusively associated. Overall, classic polygenic humorally-mediated autoimmune diseases such as RA and SLE were not associated with Dupilumab use. Pathway analysis identified several biological pathways potentially involved in Dupilumab-associated ADRs, including the fibroblast growth factor receptor (FGFR; in particular, FGFR2) pathway. miRNAs analysis revealed the potential involvement of hsa-miR-21-5p and hsa-miR-335-5p. In conclusion, IL-4/IL-13 blockers are not unexpectedly protective against humoral autoimmune diseases but dynamically skew immune responses towards some IL-23/IL-17 cytokine pathway-related diseases. A robust signal potentially towards degenerative related pathology in the eye and vasculature due to loss of IL-4/IL-13 tissue reparative homeostatic mechanisms emerged.