Wake Forest, NC—Questions have been raised about whether some atopic dermatitis treatments increase the risk of herpes infections.

Noting that atopic dermatitis (AD) is one of the most common inflammatory skin diseases and has aesthetic, physical, and emotional-social consequences when left untreated, Wake Forest University–led researchers sought to classify the most common adverse reactions associated with dupilumab treatment in patients with AD.

To do that, the authors analyzed the FDA database for common adverse reactions associated with dupilumab, topical pimecrolimus, and topical tacrolimus. The team then used phase III clinical trial data to compare the rate of herpes infections between the treatment group and placebo group.

Results reported in the Journal of the American Academy of Dermatology were that the most common adverse reactions associated with dupilumab were ocular complications. In fact, the review found that herpes infections were extremely rare in the patients with AD being treated with dupilumab.

A limitation to the analysis, according to the authors, is that prescribing information for dupilumab, topical pimecrolimus, and topical tacrolimus is not available. While adverse effects are reported by patients, healthcare providers, and pharmaceutical companies, they are not otherwise corroborated.

A small study published earlier this year from Southampton Hospital in the United Kingdom found relatively high rates, 32%, of ocular side effects from dupilumab. Most were conjunctivitis, although cicatrization and periorbital skin changes occurred in a few, according to the article in the journal Eye. But discontinuation of AD treatment was low, with most responding well to topical steroids and only a small percentage requiring cyclosporin drops, although most required ongoing treatment.

“Ocular complications are the most common complication associated with dupilumab,” according to the Wake Forest study. “The rate of herpes infection is low in patients being treated with dupilumab, topical pimecrolimus, and topical tacrolimus. There is no significant difference for the rate of herpes infection between placebo, dupilumab, topical pimecrolimus, and the topical tacrolimus treatment group, suggesting that dupilumab does not affect herpes infection rates.”

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