(P-376) Dupilumab Use and Potential Risk of Alopecia Areata: A Systematic Review

Background: Dupilumab, an interleukin-4 receptor alpha antagonist, is indicated to treat moderate-to-severe atopic dermatitis (AD), as an add-on maintenance treatment for moderate-to-severe asthma with an eosinophilic phenotype and as maintenance treatment for patients with inadequately controlled chronic rhinosinusitis with nasal polyposis.

Objectives: The review aimed to assess the association of Alopecia Areata (AA) with dupilumab use as a potential signal detected during routine pharmacovigilance activities at the Saudi Food and Drug Authority.

Methods: A systematic search was performed to identify published studies using the following database (Cochrane Central Register of Controlled Trials, Medline using PubMed interface, and Google Scholar). The search included published studies since inception to October 12, 2020, for eligible English publications with appropriate keywords, including dupilumab OR dupixent AND alopecia areata OR alopecia OR hair loss OR AA.

Results: We included ten case reports and one case series from the literature (a total of 12 cases) in our review. The Majority of the cases were male patients (n=10, 83.3%) and the age group ranged from 20 to 30 years (n=7, 58.3%). Around 40% of the patients (n=5) developed AA 1-6 weeks after receiving dupilumab and only one patient had preexisting AA which worsen after 6 weeks of starting dupilumab. Seven patients (58.3%) continued the use of dupilumab and AA improved in six patients (50%) after few months. Whereas, five patients (41.6%) discontinued dupilumab due to AA with improvement in hair loss noticed after few months of discontinuation. Ten patients (83.3%) treated AA with medications such as minoxidil or mometasone. The authors’ assessed seven cases (58.3%) as possibly induced by dupilumab and two cases (16.6%) were assessed as not related to dupilumab. Other cases (three cases), have not been assessed by the authors.

Conclusions: We suggest that there is a possible association between dupilumab and the potential risk of AA. Further studies are needed to assess the association between the risk of AA and the use of dupilumab.