Dupilumab Linked to Lower Risk of Upper Respiratory Infections in Patients With Atopic Dermatitis
A recent multicenter cohort study published in the Journal of the American Academy of Dermatology has identified dupilumab as a safer alternative to traditional immunosuppressants in reducing the risk of acute upper respiratory infections (URIs) for patients with atopic dermatitis (AD). This chronic inflammatory skin condition often requires systemic therapies for moderate-to-severe cases, with conventional immunosuppressants like methotrexate, cyclosporine, and azathioprine carrying risks of adverse effects, including infections.
Using data from the TriNetX global health records database (2017–2023), researchers compared URI incidence in patients with AD treated with dupilumab vs nontargeted immunosuppressants. After matching cohorts based on demographic factors and atopic comorbidities, results showed that dupilumab-treated patients had an 11.5% incidence of URIs over 5 years, significantly lower than the 18.3% seen in the immunosuppressant group. This translates to a 37% relative risk reduction (hazard ratio 0.79, 95% CI 0.73–0.85).
Dupilumab’s mechanism, targeting type 2 inflammation by inhibiting IL-4 and IL-13 signaling, may explain its enhanced safety profile. Researchers speculate that suppressing type 2 pathways could restore balance to Th1 and Th17 immune responses, improving defenses against viral and bacterial infections.
While the study reinforces dupilumab’s advantages, it acknowledges limitations, including the observational design and lack of therapy discontinuation data. Nonetheless, the findings highlight dupilumab as a preferred systemic therapy for moderate-to-severe AD, reducing URI risks while maintaining efficacy.
Reference
Ma EZ, Bao A, Ahmadi M, Zhang J, Kwatra SG. Dupilumab is associated with reduced risk of acute upper respiratory infections in patients with atopic dermatitis compared with nontargeted immunosuppressants: a multicenter cohort study. J Am Acad Dermatol. 2024;91(6):1282-1284. doi:10.1016/j.jaad.2024.08.047
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