Risk of Infection in Patients with Atopic Dermatitis Treated with Dupilumab: A Meta-Analysis of Randomized Controlled Trials

Publication date: Available online 4 October 2017
Source:Journal of the American Academy of Dermatology
Author(s): Patrick Fleming, Aaron M. Drucker
BackgroundAtopic dermatitis (AD) is characterized by skin barrier defects, Th2 activation, and increased risk for cutaneous and extracutaneous infections. In clinical trials, dupilumab appeared to decrease rates of skin infections in AD.ObjectiveWe aimed to determine the impact of dupilumab on rates of skin and other infections in patients with moderate-to-severe AD.MethodsWe conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) of dupilumab for AD. We searched the PubMed database for relevant studies. Risk ratios (RR) and 95% confidence intervals (CI) for skin infections, herpesvirus infections and overall infections and infestations were calculated for dupilumab compared with placebo using binary random-effects meta-analysis. For the analysis of eczema herpeticum, Peto odds ratios (OR) were calculated.ResultsEight RCTs in 4 publications with 2,706 participants were included with follow-up time ranging from 4-52 weeks. Meta-analysis including all dosing schedules and follow-up times showed a RR of skin infection of 0.54 (95% CI: 0.42-0.70) and an OR of eczema herpeticum of 0.34 (95% CI: 0.14-0.84) for dupilumab compared with placebo. No significant association was found for dupilumab with overall herpesvirus infections (RR=1.16, 95% CI: 0.78-1.74) and overall infections (RR=0.98, 95% CI: 0.83-1.16).LimitationsOur analysis is limited by short follow-up time in most trials and relatively low number of patients treated with dupilumab to date.ConclusionDupilumab is associated with a decreased incidence of skin infections and eczema herpeticum in adults with moderate-to-severe AD. The mechanism underlying this association is uncertain, but is likely related to improvement in AD severity.