Patients with moderate-to-severe atopic dermatitis (AD) are more likely to develop skin infections and systemic infections. Immunomodulators (e.g., anti-tumor necrosis factors, anti-interleukin [anti-IL]-23, anti-IL-17, Janus kinase inhibitors) increase the risk of infection. Dupilumab (a monoclonal antibody that blocks the common receptor component of IL-4 and IL-13) is authorized for moderate-to-severe Alzheimer’s disease and moderate-to-severe eosinophilic or corticosteroid-dependent asthma.

The researchers wanted to see how dupilumab affected infection rates in those with moderate-to-severe Alzheimer’s disease. Data from seven randomized, placebo-controlled dupilumab studies in individuals with moderate-to-severe Alzheimer’s disease were merged for this study. Infection rates were determined by exposure-adjusted studies.

Of the 2,932 patients, 1,091 were given a placebo, 1,095 received dupilumab 300 mg weekly, and 746 received dupilumab 300 mg every two weeks. Treatment groups had comparable total infection rates per 100 patient-years (placebo, 155; dupilumab weekly, 150; dupilumab every 2 weeks, 156; dupilumab combined, 152), as well as comparable non-skin infection rates. Dupilumab decreased serious/severe infections (risk ratio 0.43; p < 0.05), as did bacterial and other non-herpetic skin infections (risk ratio 0.44; p < 0.001). Although the overall rate of herpesviral infection was somewhat greater with dupilumab than with placebo, clinically significant herpesviral infections (eczema herpeticum, herpes zoster) were less prevalent with dupilumab (risk ratio 0.31; p < 0.01). Dupilumab reduced the utilization of systemic anti-infective medications.