Dupilumab and lymphoma risk among patients with asthma: a population-based cohort study

1. When compared with inhaled corticosteroids (ICS) plus long-acting β-agonists (LABA), dupilumab treatment was associated with an increased risk of lymphoma in asthma patients but also led to lower all-cause mortality.

Evidence Rating Level: 2 (Good)

Dupilumab, an interleukin (IL)-4α receptor monoclonal antibody, was initially approved as a treatment for atopic dermatitis and later used to treat asthma, where it has been shown to improve lung function, reduce reliance on oral corticosteroids, and decrease severe exacerbations. However, recent studies have shown an increased risk of lymphoma, particularly cutaneous T-cell lymphoma (CTCL), in patients with atopic dermatitis receiving dupilumab. Therefore, this population-based cohort study compared lymphoma incidence in 14,936 patients receiving dupilumab for asthma with 734,126 patients receiving ICS plus LABA for asthma. After propensity score matching, 14,900 patients in each group were compared for analysis. Dupilumab-treated patients were found to have a significantly increased risk of lymphoma compared to ICS/LABA-treated patients (HR 1.79, 95% CI 1.19–2.71). There were no significant differences in the rate of leukemias or malignant solid tumours. However, dupilumab-treated patients had significantly decreased all-cause mortality (HR 0.65, 95% CI 0.57–0.74). Therefore, despite the increased risk of lymphoma, patients treated with dupilumab still displayed lower all-cause mortality. This may be because asthma is inherently associated with elevated mortality risk. Future studies are required to understand the pathophysiology between dupilumab-associated lymphoma and elucidate dupilumab’s long-term safety profile.

Click here to read this study in European Respiratory Journal

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