Department of Dermatology, Brigham and Women's Hospital, 41 Avenue Louis Pasteur, 319, Boston, MA, 02115, USA.
Harvard Medical School, Boston, MA, USA.
Am J Clin Dermatol. 2023 Nov;24(6):859-864. doi: 10.1007/s40257-023-00804-5. Epub 2023 Jun 22.
Dupilumab is an interleukin (IL)-4/13 inhibitor approved by the US FDA for multiple atopic indications. It is well-known to have favorable efficacy and safety profiles; however, emerging reports of dupilumab-associated arthritis suggest an underrecognized potential adverse effect. In this article, we summarize the literature to date to better characterize this clinical phenomenon. Arthritic symptoms were most commonly peripheral, generalized, and symmetric. Onset was generally within 4 months following initiation of dupilumab, and most patients resolved fully after a matter of weeks following discontinuation. Mechanistic insights suggest that suppression of IL-4 may lead to increased activity of IL-17, a prominent cytokine in inflammatory arthritis. We propose a treatment algorithm that stratifies patients by severity, recommending that patients with more mild disease continue dupilumab and treat through symptoms, while patients with more severe disease discontinue dupilumab and consider switching to another class (e.g., Janus kinase inhibitors). Lastly, we discuss important ongoing questions that should be addressed in future studies.
度普利尤单抗是一种白细胞介素（IL）-4/13 抑制剂，已获美国食品药品监督管理局（FDA）批准用于多种特应性适应证。该药具有良好的疗效和安全性，然而，越来越多的报道表明度普利尤单抗与关节炎相关，提示其存在一种潜在的被低估的不良反应。本文对目前的文献进行了总结，以更好地描述这一临床现象。关节炎症状多为外周性、全身性和对称性。发病通常在开始使用度普利尤单抗后 4 个月内，大多数患者在停药数周后完全缓解。机制研究表明，抑制白细胞介素-4 可能导致白细胞介素-17 活性增加，而白细胞介素-17 是炎症性关节炎的一种主要细胞因子。我们提出了一种治疗算法，根据严重程度对患者进行分层，建议病情较轻的患者继续使用度普利尤单抗，并根据症状进行治疗，而病情较重的患者停止使用度普利尤单抗，并考虑改用另一种药物（如 JAK 抑制剂）。最后，我们讨论了未来研究中应解决的一些重要问题。
