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González-Uribe V, Rodríguez-Bueno CPA, Mojica-González ZS, Malagón-Liceaga A, Basile-Alvarez MR. Sustained clinical and histopathological remission in a patient with eosinophilic esophagitis and type-2 comorbidities at 18 months after discontinuation of dupilumab. Clin J Gastroenterol 2024; 17:803-808. [PMID: 39046661 PMCID: PMC11436466 DOI: 10.1007/s12328-024-02011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 06/22/2024] [Indexed: 07/25/2024]
Abstract
Eosinophilic esophagitis (EoE) is a chronic, allergen-mediated, type-2 inflammatory disease with the potential to significantly impact an individual's quality of life. Conventional treatments often result in varied responses, prompting the need for novel therapeutic approaches. We present the case of a 19-year-old male with a medical history marked by eosinophilic esophagitis, severe atopic dermatitis (AD), asthma, and allergic rhinitis. Despite undergoing diverse topical and systemic interventions to address his AD and EoE, the patient's symptoms persisted. However, following the initiation of dupilumab therapy-a dual IL-4 and IL-13 receptor antagonist-the patient experienced a substantial reduction in his Eczema Area and Severity Index score. Notably, a marked improvement was also seen regarding his symptoms of eosinophilic esophagitis. A subsequent esophageal biopsy revealed a significant decrease in eosinophilic inflammation, consistent with established clinical and histologic remission criteria. These findings corroborate the patient's reported relief from symptoms. This case underscores the potential efficacy of dupilumab as a promising therapeutic agent in managing eosinophilic esophagitis. Dupilumab offers a dual benefit of alleviating symptoms and achieving histologic and clinical remission. This novel approach presents a noteworthy advancement in the treatment of EoE.
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Affiliation(s)
- Víctor González-Uribe
- Pediatric Allergy and Clinical Immunology Department, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico
- Faculty of Medicine, Universidad La Salle México, Mexico City, Mexico
| | | | | | - Andrea Malagón-Liceaga
- Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Copilco Universidad, Escolar 411A, Coyoacán, 04360, Mexico City, Mexico
| | - Martín Roberto Basile-Alvarez
- Faculty of Medicine, Universidad Nacional Autonoma de Mexico, Copilco Universidad, Escolar 411A, Coyoacán, 04360, Mexico City, Mexico.
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2
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Achten R, van Luijk C, Thijs J, Drylewicz J, Delemarre E, Nierkens S, Bakker D, van Wijk F, de Graaf M, de Bruin-Weller M, de Boer J, Kuiper J. Non-Infectious Uveitis Secondary to Dupilumab Treatment in Atopic Dermatitis Patients Shows a Pro-Inflammatory Molecular Profile. Ocul Immunol Inflamm 2024; 32:1150-1154. [PMID: 36854134 DOI: 10.1080/09273948.2023.2182325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/02/2023]
Abstract
Severe uveitis is a rare complication of interleukin-4 receptor alpha blocking by dupilumab in topic dermatitis (AD) patients. The aim of this study was to describe five moderate-to-severe AD patients who developed uveitis during dupilumab treatment and to compare the proteomic profile of aqueous humor (AqH) of dupilumab-associated uveitis (n=3/5 available samples) with non-infectious uveitis (n=27) and cataract controls (n=11). Included patients were treated at the University Medical Center Utrecht (the Netherlands). Active dupilumab-associated uveitis complicated by serous detachment, cystoid macular edema, or secondary glaucoma developed within a median of 6.0 months (interquartile range 2.3-16.5 months) after starting dupilumab. Uveitis resolved after discontinuation of dupilumab and/or treatment with local or systemic corticosteroids. Proteomic profiling of AqH revealed that the molecular profile of dupilumab-associated uveitis resembled that of non-infectious uveitis. In conclusion, dupilumab-associated uveitis is a severe adverse event of dupilumab therapy, requiring urgent referral to an ophthalmologist.
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Affiliation(s)
- Roselie Achten
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Chantal van Luijk
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Judith Thijs
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Julia Drylewicz
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Eveline Delemarre
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Stefan Nierkens
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Daphne Bakker
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marlies de Graaf
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marjolein de Bruin-Weller
- Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Joke de Boer
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Jonas Kuiper
- Department of Ophthalmology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Tsai JH, Tsai TF. A Review of Dupilumab-Induced Adverse Events to Dermatologists and the Potential Pathogenesis in the Treatment of Atopic Dermatitis. Dermatitis 2024; 35:24-42. [PMID: 37205852 DOI: 10.1089/derm.2022.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Dupilumab, a monoclonal antibody targeting interleukin-4 antibody, is approved for use in many type 2 inflammatory diseases, including atopic dermatitis. It is generally well tolerated with no need of routine laboratory monitoring. However, several adverse events have been reported during real-world practice and in pivotal trials. We conducted a systematic literature research of the PubMed, Medline, and Embase databases to identify articles recording the clinical manifestation and potential pathogenesis of these adverse events with interests (AEIs) to dermatologists. In total, 547 cases from 134 studies have developed 39 AEIs 1 day to 2.5 years after dupilumab treatment. The most common AEIs are facial and neck dermatitis (299 cases), psoriasis (70 cases), arthralgia (56 cases), alopecia (21 cases), cutaneous T cell lymphoma (19 cases), severe ocular diseases (19 cases), and drug eruption (6 cases). Most of the AEIs recorded in this review resolved or improved after dupilumab discontinuation or the addition of another treatment, whereas 3 of the cases died of severe AEI. The potential pathogenesis included T help type 1 (Th1)/T help type 2 (Th2) imbalance, Th2/T help type 17 (Th17) imbalance, immune reconstitution, hypersensitivity reaction, transient hypereosinophilia related, and Th1 suppression. Clinicians should be alert of these AEIs for timely diagnosis and appropriate treatment.
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Affiliation(s)
- Jun-Hong Tsai
- From the Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital & National Taiwan University, College of Medicine, Taipei, Taiwan
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4
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Zhang S, Lu L, Feng J, Hu Z, Song H, Yang L, Liu Y, Chen D, Wang T. Uveitis and hypereosinophilia associated with dupilumab in an atopic dermatitis patient. J DERMATOL TREAT 2023; 34:2229466. [PMID: 37369546 DOI: 10.1080/09546634.2023.2229466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Abstract
Uveitis is a rare adverse event of dupilumab, that typically affects both eyes and often leads to discontinuation of therapy. In this article, we report a case of a 28-year-old female with atopic dermatitis who developed new-onset iridocyclitis, a form of uveitis, in her left eye 2 weeks after starting dupilumab treatment, which improved after reducing the dose, without discontinuing dupilumab. The patient also experienced asymptomatic hypereosinophilia, possibly related to dupilumab, which was gradually relieved without discontinuation. With the readers, we share our experience in managing uveitis and hypereosinophilia associated with dupilumab, which may be helpful in managing these conditions and avoiding discontinuation of dupilumab.
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Affiliation(s)
- Shiyu Zhang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, P.R. China
| | - Lu Lu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, P.R. China
| | - Jindi Feng
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, P.R. China
| | - Zhonghui Hu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, P.R. China
| | - Hongbin Song
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, P.R. China
| | - Lu Yang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, P.R. China
| | - Yuehua Liu
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, P.R. China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, P.R. China
| | - Tao Wang
- Department of Dermatology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases, Beijing, P.R. China
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5
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Sitek AN, Li JT, Pongdee T. Risks and safety of biologics: A practical guide for allergists. World Allergy Organ J 2023; 16:100737. [PMID: 36694621 PMCID: PMC9853370 DOI: 10.1016/j.waojou.2022.100737] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/01/2022] [Accepted: 12/08/2022] [Indexed: 01/18/2023] Open
Abstract
Biologic agents are a rapidly expanding class of medications, and several options are now available for the management of allergic and immunologic disorders. The risks of biologic therapy need to be understood in order to adequately counsel patients and appropriately monitor for potential adverse events. We sought to provide a comprehensive review of the risks and adverse effects reported for the current FDA-approved biologics used in management of allergic and immunologic disorders, including omalizumab, benralizumab, dupilumab, mepolizumab, reslizumab, tezepelumab and tralokinumab. Our review focuses on the risk of hypersensitivity reactions, pregnancy-specific considerations, risk of infection and risk of malignancy. We also highlight drug-specific adverse events and unique safety issues identified in case reports.
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Affiliation(s)
| | | | - Thanai Pongdee
- Corresponding author. Division of Allergic Diseases Mayo Clinic 200 First St SW Rochester, MN 55901
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Kychygina A, Cassagne M, Tauber M, Galiacy S, Paul C, Fournié P, Simon M. Dupilumab-Associated Adverse Events During Treatment of Allergic Diseases. Clin Rev Allergy Immunol 2022; 62:519-533. [PMID: 35275334 DOI: 10.1007/s12016-022-08934-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2022] [Indexed: 12/12/2022]
Abstract
Among the new biological therapies for atopic diseases, dupilumab is a fully human monoclonal antibody directed against IL-4Rα, the common chain of interleukin-4 and interleukin-13 receptors. Dupilumab showed clinical improvements in patients with atopic dermatitis, asthma, and chronic rhinosinusitis and is currently under development for other indications. While dupilumab is considered to be well tolerated, a number of recent publications have reported various adverse events. This review aims to summarize the current knowledge about these adverse events, which may help clinicians to improve the follow-up of patients on dupilumab. Injection-site reactions are the most common reported adverse event. However, dupilumab has also been shown to cause ophthalmic complications (e.g., dry eyes, conjunctivitis, blepharitis, keratitis, and ocular pruritus), head and neck dermatitis, onset of psoriatic lesions, progression of cutaneous T-cell lymphoma exacerbation, alopecia areata, hypereosinophilia, and arthritis. Most are managed during dupilumab treatment continuation, but some (e.g., severe conjunctivitis) may result in a discontinuation of treatment. Their molecular origin is unclear and requires further investigations. Among other hypothesis, it has been suggested that T helper (Th)2-mediated pathway inhibition may worsen Th1/Th17-dependent immune responses. An ophthalmological examination for the presence of potential predictive indicators of ophthalmic adverse events is recommended before initiation of dupilumab therapy.
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Affiliation(s)
- Anna Kychygina
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France
| | - Myriam Cassagne
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Marie Tauber
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Dermatology, CHU and Toulouse III University, Toulouse, France
| | - Stéphane Galiacy
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Carle Paul
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Dermatology, CHU and Toulouse III University, Toulouse, France
| | - Pierre Fournié
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.,Department of Ophthalmology, Toulouse Hospital, Toulouse, France
| | - Michel Simon
- Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.
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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. J Invest Dermatol 2022; 142:2660-2667. [PMID: 35395222 DOI: 10.1016/j.jid.2022.03.013] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/02/2022] [Accepted: 03/18/2022] [Indexed: 01/17/2023]
Abstract
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.
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