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

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*

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

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.