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2024-03-11T16:43:32.000Z

Dupilumab in recalcitrant pediatric atopic dermatitis-like graft-versus-host disease: A case series

Mar 11, 2024
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Learning objective: After reading this article, learners will be able to cite a new clinical development in graft-versus-host disease.

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Graft-versus-host disease (GvHD) can present in multiple organs, with the most common first clinical manifestations often being cutaneous.1 While the number of indications for allogeneic hematopoietic stem cell transplantation (HSCT) is expanding, healthcare professionals are challenged with treating various forms of cutaneous GvHD.1 The current first-line treatment option for moderate-to-severe cutaneous GvHD is systemic corticosteroids, either alone or in combination with immunosuppressive therapies.1 A potential alternative to corticosteroids is dupilumab, a monoclonal antibody therapy targeting interleukin-4Rα.1

Here, we summarize a case series published by Belmesk et al.1 in JAAD Case Reports on the successful use of dupilumab in treating recalcitrant pediatric atopic dermatitis-like (AD-like) GvHD.

Method1

For the case series by Belmesk et al.,1 the records were assessed of patients diagnosed with AD-like GvHD, who were refractory to conventional therapies, at the Universite de Montreal, Canada.

Key findings1

In this case series, the effectiveness of dupilumab treatment was assessed (Table 1).

Table 1. Patients’ dermatologic severity score before and after dupilumab*

Case

BSA (%)

IGA score

DLQI score

Pre-treatment

Post-treatment

Pre-treatment

Post-treatment

Pre-treatment

Post-treatment

1

48

0

4

1

26

1

2

10

1

4

0

19

9

3

55

0

4

0

25

0

4

26

6

3

1

16

3

BSA, body surface area; DLQI, Dermatology Life Quality Index; IGA, Investigator Global Assessment scale.
*Data from Belmesk L, et al.1


Figure 1. Clinical case overviews*  

AD-like, atopic dermatitis-like; SC, subcutaneously; GvHD, graft-versus-host disease, HSCT, hematopoietic stem cell transplantation; MMF, mycophenolate mofetil; nbUVB, narrow-band ultraviolet B; TCI, topical corticosteroids and calcineurin inhibitors.  
*Data from Belmesk L, et al.1 

 

Key learnings1

  • Dupilumab has the potential to be an alternative therapeutic option for the treatment of patients with AD-like dermatitis post-HSCT.
  • Further studies are needed to assess the safety and efficacy of dupilumab to treat AD-like GvHD.

  1. Belmesk L, Hatami A, Powell J, et al. Successful use of dupilumab in recalcitrant pediatric atopic dermatitis-like graft-versus-host disease: A case series. JAAD Case Rep. 2024;44:11-16. DOI 1016/j.jdcr.2023.11.003.

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