Dupilumab Therapy for Atopic Dermatitis is Associated with Increased Risk of Cutaneous T Cell Lymphoma

In a presentation by Dr. Zachary Zen, a pediatric dermatologist, the association between dupilumab therapy for atopic dermatitis and an increased risk of cutaneous T cell lymphoma (CTCL) was discussed. Existing literature suggests that patients with atopic dermatitis have a higher risk of lymphomas, and recent case reports have indicated that dupilumab may exacerbate or lead to new cases of CTCL. Utilizing the Chinadex database, the study evaluated over one million patients with atopic dermatitis, finding 23,000 exposed to dupilumab. The analysis revealed a significant adjusted odds ratio of 4.1 for CTCL, which remained notable even after controlling for prior use of disease-modifying antirheumatic drugs (DMARDs). In a further refined cohort, the odds ratio for CTCL was 3.2. Out of 41 new cases of CTCL identified, 9 occurred within six months of starting the therapy, while 27 manifested after one year, indicating that some cases might be unmasked rather than solely newly developed. The research highlights that the increased incidence of CTCL is notable even after excluding patients with prior DMARD use, with a calculated number needed to harm of 833. However, the study acknowledges significant limitations, including the lack of assessment for disease severity and the possibility that some lymphoid proliferations could be benign or reversible. Moving forward, it is essential to explore CTCL incidence in patients receiving dupilumab for other indications and compare with other treatments for atopic dermatitis.