Risk of CTCL with Dupixent
Question:
9/25/2025
I received a message from a parent of a 17-month-old child with severe atopic dermatitis regarding the association of Dupixent with malignancy. The patient has responded very well to Dupixent therapy started three months ago. The mom states that she read on social media that Dupixent is associated with malignancy and she is concerned due to patient's age. The AAAAI/AAD all report no significant association of Dupixent with malignancy. An online search references two sources that I am not familiar with (Dermatologic Therapy, TriNetX database) report an increased risk of CTCL in patient on Dupixent. I informed the parent that CTCL is a difficult to diagnose, and often requires multiple biopsies before a correct diagnosis. I also advised her that patients with CTCL can often be misdiagnosed as having AD and placed on Dupixent and this does not indicate causation. This parent is comfortable restarting Dupixent. Do you have any thoughts?
Answer:
Hasan et al published a study evaluating risk of malignancy with use of dupilumab in patients with atopic dermatitis using the TrinetX database. In the study they found that compared to patients with atopic dermatitis who were not treated with dupilumab, patients with atopic dermatitis who were prescribed dupilumab had a higher risk of developing CTCL (OR 4.1003, 95% confidence interval 2.055-8.192). In another analysis by Neubauer et al, they did not find an association of dupilumab with CTCL and concluded that “the association between dupilumab and CTCL is explained by dupilumab treatment unmasking preexisting CTCL.”
To date, there are no prospective randomized controlled trials that definitively answer this question. The available data should be discussed with the patient and family in a shared decision-making process to determine best management options.
1. Hasan I, Parsons L, Duran S, Zinn Z. Dupilumab therapy for atopic dermatitis is associated with increased risk of cutaneous T cell lymphoma: A retrospective cohort study. J Am Acad Dermatol. 2024 Aug;91(2):255-258. doi: 10.1016/j.jaad.2024.03.039.
2. Neubauer ZJK, Brunner PM, Geskin LJ, Guttman E, Lipner SR. Decoupling the association of dupilumab with cutaneous T-cell lymphoma. J Am Acad Dermatol. 2024 Dec;91(6):1296-1298.
Princess Ogbogu, MD, FAAAAI