Abstract

Background: Dupilumab is a monoclonal antibody that inhibits IL-4 and IL-13 approved for the treatment of adults with atopic dermatitis (AD). Recent reports have described new-onset Mycosis Fungoides (MF) following treatment with Dupilumab with progression to Sezary Syndrome (SS) in rare cases. Early stages of MF and AD carry similarities both clinically and histopathologically and there is debate as to whether early-stage MF is misdiagnosed as AD or if Dupilumab promotes the transformation of AD into MF in these patients. Our aim was to investigate Dupilumab as a catalyst for the progression of MF. Methods: An institutional data registry and literature search were used for a retrospective study. Only patients with a diagnosis of MF on Dupilumab for the treatment of AD and eczematous dermatitis were included. Multiple regression models were used to assess the correlation coefficient. Results: Three eligible patients were identified at our institution. In addition, the PubMed review identified an additional 21 patients. The median age was 58 years with 42% female. All patients were diagnosed with MF and one patient developed SS, while on Dupilumab, with an average duration of 7.5 months of therapy prior to diagnosis. The tumor stage was described in 19 of the cases and ranged from an early-stage disease (IA) to advanced disease (IV). Treatment strategies included narrow-band UVB therapy, topical corticosteroids, brentuximab, praladextrate, and acitretin. Male gender, advanced-stage disease, older age correlated significantly with the hazard of MF development and shorter treatment duration. Conclusion: Our results suggest a correlation between the duration of Dupilumab treatment and the diagnosis of MF. The longer the treatment duration the earlier the disease progression, in older males with more advanced disease. A close monitoring of these patients and a further investigation of the relationship between Dupilumab and MF can shed more light on this question.

Financial Disclosure:
No current or relevant financial relationships exist.