Is Dupilumab an Immunosuppressant?

Abstract

Atopic dermatitis (AD) is a chronic, immune-related, inflammatory skin disease that significantly reduces quality of life. In severe AD, systemic immunosuppressants are often utilized, though they do not target specific biologic pathways of AD. A non-immunosuppressive treatment may offer the possibility of high efficacy with better safety. Dupilumab, the only FDA-approved biologic for AD (approved for adults and adolescents 12 and older), is a fully human monoclonal IgG4ҡ antibody that inhibits IL-4 and IL-13 signal. To date, there is no evidence that dupilumab has immunosuppressive effects. On the contrary, by decreasing Staphylococcus colonization and partially normalizing the skin microbiome, likely via direct effects on the innate immune system, dupilumab appears to improve immunologic protection against infections. To date, no study has reported reactivation of latent infections (such as hepatitis B or tuberculosis, invasive fungal infection or unusual opportunistic infections) or progression of malignancy in association with dupilumab. Data on dupilumab’s safety is limited by the short follow-up time in most trials and the relatively low number of patients treated to date. Keeping those limitations in mind and based on current best evidence, it appears that dupilumab may enhance innate immune function in patients with AD. J Drugs Dermatol. 2020;19(2)209-210 doi:10.36849/JDD.2020.4722