Infinity, Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), Toulouse University, CNRS, Paul Sabatier Toulouse III University, Inserm, Toulouse, France.
Department of Ophthalmology, Toulouse Hospital, Toulouse, France.
Clin Rev Allergy Immunol. 2022 Jun;62(3):519-533. doi: 10.1007/s12016-022-08934-0. Epub 2022 Mar 11.
Among the new biological therapies for atopic diseases, dupilumab is a fully human monoclonal antibody directed against IL-4Rα, the common chain of interleukin-4 and interleukin-13 receptors. Dupilumab showed clinical improvements in patients with atopic dermatitis, asthma, and chronic rhinosinusitis and is currently under development for other indications. While dupilumab is considered to be well tolerated, a number of recent publications have reported various adverse events. This review aims to summarize the current knowledge about these adverse events, which may help clinicians to improve the follow-up of patients on dupilumab. Injection-site reactions are the most common reported adverse event. However, dupilumab has also been shown to cause ophthalmic complications (e.g., dry eyes, conjunctivitis, blepharitis, keratitis, and ocular pruritus), head and neck dermatitis, onset of psoriatic lesions, progression of cutaneous T-cell lymphoma exacerbation, alopecia areata, hypereosinophilia, and arthritis. Most are managed during dupilumab treatment continuation, but some (e.g., severe conjunctivitis) may result in a discontinuation of treatment. Their molecular origin is unclear and requires further investigations. Among other hypothesis, it has been suggested that T helper (Th)2-mediated pathway inhibition may worsen Th1/Th17-dependent immune responses. An ophthalmological examination for the presence of potential predictive indicators of ophthalmic adverse events is recommended before initiation of dupilumab therapy.
在特应性疾病的新型生物疗法中，度普利尤单抗是一种针对白细胞介素-4 受体α（IL-4Rα）的全人源单克隆抗体，白细胞介素-4 和白细胞介素-13 受体的共同链。度普利尤单抗在特应性皮炎、哮喘和慢性鼻-鼻窦炎患者中显示出临床改善，目前正在开发用于其他适应症。虽然度普利尤单抗被认为具有良好的耐受性，但最近有许多出版物报道了各种不良事件。本综述旨在总结这些不良事件的现有知识，这可能有助于临床医生改善对度普利尤单抗治疗患者的随访。注射部位反应是最常见的报告不良事件。然而，度普利尤单抗也已被证明会引起眼部并发症（如干眼症、结膜炎、睑缘炎、角膜炎和眼部瘙痒）、头颈部皮炎、银屑病病变的发作、皮肤 T 细胞淋巴瘤恶化的进展、斑秃、嗜酸性粒细胞增多和关节炎。大多数在继续度普利尤单抗治疗期间得到管理，但有些（如严重结膜炎）可能导致治疗中断。其分子起源尚不清楚，需要进一步研究。在其他假设中，有人认为 Th2 介导的途径抑制可能会加重 Th1/Th17 依赖性免疫反应。建议在开始度普利尤单抗治疗之前进行眼科检查，以寻找潜在的眼部不良事件预测指标。
