Combined use of Omalizumab and dupilumab: safety and efficacy data from a large academic center

Abstract

Biologic therapies have revolutionized the treatment of inflammatory skin conditions. Omalizumab is a biologic used for the treatment of asthma and chronic idiopathic urticaria (CIU), while Dupilumab is used for the treatment of Th2 pathway mediated diseases like atopic dermatitis (AD). Patients can present with concurrent immune-mediated conditions requiring the use of dual biologic therapy; however, there is no robust data to support this. We conducted a retrospective review of outpatient charts between January 2018- July 2024 at a large academic center to find patients with concurrent use of Omalizumab and Dupilumab. Diagnoses and indications for treatments, prior therapies, therapy regimen, therapy duration, adverse events, and new medications were recorded. There were 23 patients prescribed dual biologic therapy. The most common indication for omalizumab was CIU (n = 14) while for dupilumab was AD (n = 20). The median duration of dual therapy was 7 months, with a range of 1 to 41 months. The patient with the longest record of dual therapy was 41 months, with no severe adverse events and a robust clinical response. Of the 23 patients, 65% (n = 15) are currently continuing treatment. Of the 8 patients who discontinued therapy, the reasons included adverse events (n = 2), lack of response (n = 2), insurance issues (n = 1), and switch to monotherapy after improvement (n = 2). Most patients treated with dual therapy were able to obtain improvement for both conditions prescribed. This study showed real-world safety and efficacy of combination of Omalizumab and Dupilumab. Limitations of our study include a small sample size, a one-year average follow-up period, and its retrospective nature.

Keywords: Asthma; Atopic dermatitis; Dermatology; Immunobiologics; Urticaria.