CRA24 THE MANY FACES OF DUPILUMAB-INDUCED ARTHRITIS IN SEVERE ASTHMA: A CASE SERIES

Yee Von Wong, Subramaniam Ponnuvelu, Larry Ellee Nyanti, Meryl Grace Lansing, Shan Min Lo, Nai Chien Huan, Hema Yamini Ramarmuty, Kunji Kannan Sivaraman Kannan
Respiratory Department, Queen Elizabeth Hospital, Kota Kinabalu

Introduction

Dupilumab, an IL-4Rα-targeting monoclonal antibody, has emerged as an effective treatment for severe eosinophilic asthma. To date, dupilumab-associated inflammatory arthritis (DAIA) represents a relatively unknown adverse event among severe asthma patients and is sporadically reported in patients with chronic rhinosinusitis with nasal polyps or atopic dermatitis. We describe three cases of DAIA with unique presentations and outcomes in the context of severe asthma management.

Objective

Importance of monitoring for musculoskeletal symptoms in patients receiving Dupilumab (300mg) for severe asthma. 

Methodology

Retrospective analysis of medical records from Hospital Queen Elizabeth, Sabah from January 2023 to July 2024.

Results

Case 1 was a 59-year-old female who complained of bilateral shoulder joint pain after her fourth dose of Dupilumab. Her symptoms resolved with oral analgesia. Case 2 was 53-year-old female who developed bilateral foot pain and myalgia affecting activities of daily living (ADL) after her initial dose of Dupilumab, refractory to pharmacotherapy. A decision was made to administer a lower dose (200mg) of Dupilumab after multidisciplinary discussion. With the reduced dose, her symptoms almost completely resolved, and she regained her usual ADL. Case 3 was a 60-year-old male presenting with bilateral wrist and ankle joint pain with bilateral foot swelling after the 6th dose of Dupilumab, which was subsequently well-controlled with oral analgesia and anti-inflammatory medications. 

Conclusions

Current postulations link DAIA to T-helper 17-driven processes. Further research is needed to elucidate the mechanisms underlying dupilumab-induced arthritis and to establish optimal management protocols. Patient-provider discussion should include the benefits of Dupilumab in asthma control with the potential risk of DAIA.