Atopic Dermatitis Treated Safely with Dupilumab during Pregn
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Dupilumab is currently the only biologic treatment approved for moderate-to-severe atopic dermatitis. Though limited, available clinical data describing dupilumab use in pregnancy have not identified a drug-associated risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes. Systemic treatment in pregnant women with atopic dermatitis is currently restricted to corticosteroids, cyclosporine A, and azathioprine. Atopic dermatitis often has a deleterious course in pregnancy which can cause substantial distress and significantly impact global health and quality of life.

A 36-year-old gravida 1 para 1 woman presented to our dermatology clinic with severe AD since early childhood. Her past medical history was significant for allergic rhinoconjunctivitis and asthma. Previous treatments for AD included high-potency topical corticosteroids (TCS), systemic corticosteroids (SCS), narrowband ultraviolet-B (UVB) phototherapy, methotrexate, and a 12-month course of cyclosporine A. On examination, she had diffuse AD affecting 86% of her total body surface area, with an Eczema Area and Severity Index (EASI) score of 67.4, and an Investigator Global Assessment score of 4, indicating severe disease. The patient was commenced on dupilumab with a loading dose of 600 mg followed by 300 mg every other week. Within four weeks of treatment, her AD had improved significantly. At week 16 of treatment, she had an EASI score of 1.7. Due to eye-related adverse effects, dosing was decreased to 3-weekly with eventual resolution of symptoms. She became pregnant 12 months later but continued to receive dupilumab until 24 weeks and 4 days gestation after careful risk-benefit assessment.

Apart from gestational diabetes, there were no other antenatal complications. Within a few weeks of cessation, she experienced a severe flare of AD, reflected by an EASI score of 40.1, which was refractory to emollients, oral antibiotics, and UVB phototherapy. She decided against treatment with TCS and SCS. At 37 weeks and 4 days gestation, a healthy female infant (weight 3,120 g, length 48.5 cm) was born via an uncomplicated spontaneous vaginal delivery, and shortly after, dupilumab was recommenced. The patient chose not to breastfeed while receiving dupilumab. Six weeks after reintroduction of dupilumab, she showed significant skin clearance with an EASI score of 4.2.