New Guidance Addresses Dupilumab Use in Specific, Common Situations

Patients with suspected or confirmed COVID-19 can continue dupilumab therapy for atopic dermatitis, advised an expert panel of Canadian dermatologists in recommendations published online ahead of print in Dermatology and Therapy.

Among the 12 board-certified dermatologists on the panel, the statement garnered 91.7% agreement. A statement that dupilumab is unlikely to impact the effect of COVID-19 vaccination, and is not associated with any additional safety risk for patients, drew 92.8% agreement.

In publishing the recommendations, the panel aimed to provide an evidence-based framework for prescribers in specific situations, the authors explained.

“Since its approval, practical issues related to the use of dupilumab for atopic dermatitis have arisen,” the authors wrote, “with particular interest in transitioning from current therapies and managing medication overlap, considerations for special populations of patients with atopic dermatitis, and management of potential adverse events.”

The published recommendations each achieved an 80% or higher level of agreement from the expert panel. They include the following advice:

• Patients with partial or nondurable response to dupilumab may benefit from increasing to weekly dosing.
• For those with an inadequate response to dupilumab, the addition of a traditional systemic agent may help.
• During pregnancy, dupilumab poses little risk to the mother or fetus.
• Absorption of dupilumab by infants breastfed by women taking dupilumab is negligible.
• In most patients with prior or active malignancies, dupilumab poses no known additional risk.
• In patients with pre-existing immune disorders, dupilumab is unlikely to increase risks.
• The medication poses no additive safety concerns for older adults, although those with atypical presentation should have their atopic dermatitis diagnosis confirmed to rule out cutaneous T-cell lymphoma.

The guidance also addresses the handling of various adverse events with dupilumab, including conjunctivitis, recalcitrant head and neck dermatitis, and paradoxical psoriasiform eruption.

Reference:
Papp KA, Hong CH, Lansang MP, et al. Practical Management of Patients with Atopic Dermatitis on Dupilumab [published online ahead of print, 2021 Sep 11]. Dermatol Ther (Heidelb). 2021;1-24. doi:10.1007/s13555-021-00586-w