Dupilumab in Atopic Dermatitis Linked to Significant Weight Gain, Study Finds
Ireland: A new study from researchers at Tallaght University Hospital, Dublin, highlights a potential link between dupilumab therapy and weight gain in individuals with atopic dermatitis (AD). The findings, published in Clinical and Experimental Dermatology by Dr. Darren Roche and colleagues, suggest that blocking interleukin-4 (IL-4) activity may influence metabolic regulation, resulting in measurable changes in body weight for some patients.
Dupilumab, a monoclonal antibody that targets the IL-4 receptor alpha, has become a cornerstone treatment for patients with moderate-to-severe AD due to its ability to control inflammation. However, IL-4 also plays a role in metabolism, raising concerns that interfering with this pathway could have unintended effects. To explore this, the research team conducted a retrospective chart review of patients treated with dupilumab between April 2018 and December 2023. Only those who had received treatment for at least six months and had weight data available before and after therapy were included. Thirty patients met the criteria, with a mean age of 40 years; 21 were men and nine were women.
Key Findings:
- The group’s average baseline weight was 81.5 kg.
- After six months or more of therapy, 67% of patients gained weight, with an average increase of 5.9 kg.
- Seven patients (23%) maintained stable weight.
- Three patients (10%) experienced a mean weight reduction of 3.7 kg.
- Overall, participants showed a mean weight gain of 3.6 kg, ranging from –8 to +13 kg.
- The results align with previous studies indicating similar weight increases, suggesting dupilumab may influence metabolic changes in addition to its immunologic effects.
The mechanism behind this trend remains uncertain, but researchers suggest that IL-4 blockade could influence appetite regulation and energy balance, creating a physiological environment conducive to weight gain. Still, the relationship is likely complex. Weight fluctuations in AD patients can also be shaped by disease severity, systemic inflammation, stress, and lifestyle behaviors—factors that complicate direct attribution to medication alone.
Although the majority of patients tolerated dupilumab well, the potential for weight gain may have implications for long-term metabolic health. The study’s authors stress the importance of monitoring weight during treatment and recommend that clinicians discuss this possibility with patients, particularly those already at risk of obesity or metabolic disorders.
“While our data suggest an association between dupilumab and weight gain, more research is needed to fully understand the biological pathways involved,” the authors noted. They call for prospective studies to clarify whether the observed changes stem directly from IL-4 inhibition or other interacting factors.
"The study adds to growing evidence that dupilumab, while highly effective for managing atopic dermatitis, may also be linked to unintended metabolic side effects. As usage of the drug expands worldwide, balancing therapeutic benefits with potential long-term risks will remain a critical area of investigation," they concluded.
Reference:
Roche, D., Kirby, B., & Alsharqi, A. An observation of weight gain in patients with atopic dermatitis receiving dupilumab. Clinical and Experimental Dermatology. https://doi.org/10.1093/ced/llaf292
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