Is Dupixent (dupilumab) used to treat psoriasis?

Dupilumab is Not Approved for Psoriasis Treatment

Dupilumab (Dupixent) is not approved or recommended for the treatment of psoriasis. In fact, evidence suggests that dupilumab may actually induce or exacerbate psoriasis in some patients.

Approved Biologics for Psoriasis

The American Academy of Dermatology (AAD) and National Psoriasis Foundation (NPF) guidelines clearly outline the approved biologic therapies for psoriasis, which include:

1. TNF-α inhibitors:

   • Etanercept
   • Infliximab
   • Adalimumab
   • Certolizumab 1

2. IL-12/IL-23 inhibitors:

   • Ustekinumab 1

3. Other biologics approved for psoriasis (mentioned in guidelines but not detailed in the provided evidence):

   • IL-17 inhibitors (secukinumab, ixekizumab)
   • IL-23 inhibitors

Dupilumab's Approved Indications

Dupilumab is specifically approved for:

• Atopic dermatitis (as first-line systemic therapy)
• Asthma
• Chronic rhinosinusitis with nasal polyps 2

Dupilumab and Psoriasis: Adverse Relationship

Rather than treating psoriasis, dupilumab has been associated with:

• De novo psoriasis development: Multiple case reports document new-onset psoriasis in patients receiving dupilumab for atopic dermatitis 3
• Psoriasis exacerbation: In patients with pre-existing psoriasis, dupilumab can trigger flares 3

A recent large cohort study found:

• Patients with atopic dermatitis treated with dupilumab had a 58% higher risk of developing psoriasis compared to those on other systemic agents (HR 1.58; 95% CI, 1.25-1.99)
• The number needed to harm was 94 patients 4
• The 3-year cumulative psoriasis incidence was higher in dupilumab-treated patients (2.86% vs 1.79%) 4

Psoriasis Induced by Dupilumab: Clinical Patterns

When dupilumab induces psoriasis, it typically presents as:

• Plaque psoriasis, most commonly affecting the scalp and extremities
• Average onset around 4-5 months after starting dupilumab
• In some cases, discontinuation of dupilumab is required to resolve the psoriasis 3, 5

A retrospective study found that among 916 patients treated with dupilumab for atopic dermatitis, 39 (4.25%) developed psoriasis, with 10 patients (1.09%) requiring discontinuation of dupilumab due to psoriasis severity 5.

Conclusion

For patients with psoriasis, appropriate biologic options should be selected from the FDA-approved agents recommended in the AAD-NPF guidelines. Dupilumab should be avoided in patients with psoriasis or a strong family history of psoriasis when treating their atopic dermatitis, as it may trigger or worsen psoriatic disease.