Joint Pain and Inflammatory Arthropathy after Dupilumab Use in Atopic Dermatitis: A Systematic Review and Meta-Analysis

Dupilumab has emerged as an important treatment for inadequately controlled moderate-to-severe atopic dermatitis (AD). However, joint pain after dupilumab use has prompted the inclusion of arthralgia in the Summary of Product Characteristics of dupilumab. In this article we reviewed arthritis and inflammatory arthropathy as an adverse effect of dupilumab treatment for AD. A comprehensive search was performed for randomized controlled trials, observational studies, case series, and case reports analyzing joint pain prevalence among AD patients treated with dupilumab. This study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 checklist and quality was assessed via the Newcastle-Ottawa Quality Assessment Scale (NOS). Forty-three studies were included in the systematic review, and 34 studies (15,101 patients) were included in the meta-analysis. Among the 34 studies, the pooled prevalence of joint pain among dupilumab patients was 1.74% (95% confidence interval [CI]: 1.12-2.68). Among the eight studies that reported inflammatory arthropathy prevalence among dupilumab patients, the pooled prevalence of inflammatory arthropathy among dupilumab patients was 2.62% (95% CI: 1.44-4.70). Among the eight studies with a control group, the overall relative risk of developing joint pain after dupilumab use for AD was not significantly higher at 0.68 (95% CI: 0.29-1.58, P = 0.31), compared to the control group. Although our findings found that there is insufficient evidence to suggest that dupilumab use was associated with joint pain, the prevalence of joint pain observed among patients treated with dupilumab may warrant proactive surveillance in clinical practice.