Dupilumab
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Unmasking and progression of Mycosis fungoides, cutaneous T-cell lymphoma progression and off-label use: 7 case reports In a chart review, 7 patients (3 women and 4 men) aged 40–77 years were described, who developed Mycosis fungoides unmasking, Mycosis fungoides progression or cutaneous T-cell lymphoma progression during treatment with dupilumab for presumed atopic dermatitis (AD) or Mycosis fungoides (MF). Three of the 7 patients received off-label use dupilumab for MF [dosages, routes and times to reactions onsets not stated; not all outcomes clearly stated]. The patients, who had presumed AD or MF (stage IIIb, IIa or Ib), started receiving dupilumab. In three of the 7 patients, dupilumab was used off-label for MF. Dupilumab was administered for a total of 3–24 months. The patients additionally received various other co-medications. However, the patients developed unmasking (4 patients; stage Ia, Ib or IIIa) and worsening of MF (3 patients), which manifested as Palmoplantar desquamation, severe skin burning/pruritus, erythroderma, impetiginisation with Staphylococcus aureus, thickening of plaques with superimposed papules, enlargement of facial plaque, fatigue, weight-loss, erythroderma, blepharoconjunctivitis, worsening pruritus, Palmoplantar desquamation or lymphadenopathy. In one of the 4 patients, who exhibited unmasking, retrospective diagnosis of CTCL-NOS stage Ib was made, which progressed to stage IIIa due to dupilumab. Dupilumab therapy was withdrawn in six of the 7 patients. However, in one of the 7 patients, dupilumab was continued at longer intervals (300mg every 3.5 weeks). In three of the four unmasked patients, an improvement was noted with radiation, bexarotene, interferon-α, narrow-band ultraviolet B phototherapy (NBUVB), unspecified topical corticosteroids, prednisone taper, triamcinolone or methotrexate; in the remaining 1 patient, patient preference and atopic benefits [sic] was given. The remaining 3 patients with progressive disease (PD) developed stage IVa Sezary syndrome. Among the three patients with PD, one patient, who developed endocarditis, achieved partial response with romidepsin, while two patients died eventually [immediate causes of death not stated]. Espinosa ML, et al. Progression of cutaneous T-cell lymphoma after dupilumab: Case review of 7 patients. Journal of the American Academy of Dermatology 83: 197-199, 803501790 No. 1, Jul 2020. Available from: URL: http://doi.org/10.1016/j.jaad.2020.03.050
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Reactions 19 Sep 2020 No. 1822
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