Overview of use, efficacy, and safety of dupilumab in complex patients: a retrospective, case-series study from a large, urban academic center.

Dupilumab has emerged as an effective treatment option for those suffering from moderate-to-severe atopic dermatitis (AD). Since its approval in 2017 by the United States Food and Drug Administration, dupilumab demonstrated efficacy in a wide range of "off-label" dermatologic conditions. With its increasing use, dermatologists must navigate prescribing dupilumab in complex patient populations. To that end, we performed a single-institution, retrospective, case-series study to assess efficacy, tolerability, and safety of dupilumab in elderly, patients on concomitant immunosuppressive/immunomodulating therapies, and those with pre-existing co-morbidities (e.g., malignancies, chronic renal and/or liver diseases, organ transplantation, hematologic malignancies, and infection). We conducted chart reviews of 248 patients who were prescribed dupilumab between January 1, 2017 and August 31, 2021, and identified 64 patients who met the criteria of being in the complex patient group as described above. Our results showed that 87.5% (56/64) of complex patients demonstrated improvement and/or disease clearance on dupilumab. 20.3% (13/64) of them experienced one or more side effects reported as conjunctivitis, seborrheic dermatitis, psoriasiform eruption, xerosis, facial burning sensation, anaphylactic reaction/angioedema, and worsening of AD. 9.4% (6/64) of them discontinued dupilumab due to the side effects. These findings demonstrated that dupilumab can be safely considered in certain complex patient populations such as elderly and those with significant pre-existing co-morbidities and can be safely combined with immunosuppressive medications and/or other biologic therapies. In the future, more studies with long-term follow-up are needed to validate the efficacy and safety of dupilumab in these challenging patients with complex medical histories.