26229 Use of dupilumab for atopic dermatitis in young post-transplant patients: A case series of 2 patients

Abstract

Rates of atopic dermatitis (AD) are as high as 43% in posttransplant patients. Most systemic treatments for AD are immunosuppressive or risk organ toxicity, limiting their use. Dupilumab, an IL-4a/13 receptor antagonist, has shown promise as a safe therapy for posttransplant AD but all 4 reports were in adult patients. In this series, we describe the successful treatment of AD in 2 young posttransplant patients with dupilumab. Patient A is a 15-year-old female 10 years post renal transplant with 10 years of severe AD. Topical therapies proved ineffective, so weight-based dosing of dupilumab was initiated. On follow-up, significant improvement in her AD was noted. Dupilumab was discontinued prior to a required second transplant due to inexperience with use after transplant. Unfortunately, her AD worsened severely 3 months posttransplant, so dupilumab was resumed and her dermatitis cleared, with no signs of transplant rejection or infection. Patient B is a 21-year-old female 6 years post auto-islet cell transplant with lifelong AD. Topical therapies were ineffective, so dupilumab was started. On follow-up, she had marked improvement in her AD without changes in her blood glucose control or HbA1C. Her inhaler requirements for her asthma also decreased. To our knowledge, this is the first report of successful use of dupilumab in young transplant patients. Dupilumab preferentially downregulates the Th2 pathway implicated in AD, which may explain its safety in the posttransplant setting. In our experience, dupilumab is effective and well tolerated in the posttransplant setting, though larger studies are needed to confirm these findings.