SUMMARY

• The company cannot recommend any practices, procedures or usage that deviate from the approved labeling.
• Case reports and data from a retrospective chart review described the use of TREMFYA in combination with dupilumab.^1-3 

CLINICAL DATA

Kaszycki et al (2023)¹ described a case of a patient with concurrent, treatment-resistant atopic dermatitis (AD) and psoriasis (PsO) who was treated successfully with TREMFYA and dupilumab.

• A 62-year-old female presented with a 12-year duration of red itchy scales and painful fissures on the palms, hands, and soles.
• Previous treatment for PsO included topical corticosteroids, keratolytics, and calcineurin inhibitors with minimal or no relief.
• Patient began a trial of systemic agents, including methotrexate, etanercept, adalimumab, and apremilast for 6 to 10 months with no improvement.
• Two years prior to her current presentation, the patient was treated with TREMFYA, which provided moderate disease improvement.
• Dermatological examination during TREMFYA treatment showed prurigo with excoriations of the extremities, hyperkeratosis with scaling and fissures of the soles, erythematous scaly plaques on the palms and dorsal surface of the hands, and mild oncholysis of the nails.
• Dupilumab was initiated along with TREMFYA due to concern regarding concomitant intrinsic AD.
• The patient achieved near-complete resolution of symptoms after 1 year of dual therapy with TREMFYA and dupilumab (PsO resolved from an initial body surface area [BSA] of 5%, and the AD BSA decreased from 30% to 2%), without experiencing any adverse events.

Megna et al (2022)² described a case of a 62-year-old male patient with biologic induced eczematous eruptions (EE) and was treated with TREMFYA in combination with dupilumab.

• An adult patient with a 15-year history of PsO presented with a diffuse pruritic rash.
• Previous treatment included methotrexate, and apremilast, inconsistent improvement was seen with both treatments.
• Patient began treatment with brodalumab and after 8 months developed a diffuse pruritic eczematous rash. Upon physical examination, patient presented with palmoplantar PsO and eczematous patches on his trunk and limbs with multiple excoriation and scratch marks.
• The patient was diagnosed with suspected brodalumab induced EE and was treated with topical (mometasone) and systemic (betamethasone, followed by triamcinolone) corticosteroids with transitory improvement.
• The patient also experienced severe uncontrolled itch, despite also receiving desloratadine 3 times a day.
• Brodalumab was discontinued and the patient began receiving TREMFYA.
• After 8 weeks, dupilumab was added as a concomitant therapy due to severe itch and partial improvement in skin lesions was observed with TREMFYA.
• Patient achieved an almost complete clearance and itch control and continued to receive TREMFYA and dupilumab combination treatment with stable results up to week 16.

Retrospective Chart Review

Barry et al (2021)³ reported on the use of dupilumab in combination with biologics, including TREMFYA for treatment of plaque PsO.

Study Design/Methods

• A retrospective chart review from the Tufts Medical Center Department of Dermatology assessed the use of dupilumab in combination with a biologic between January 1, 2016, and May 1, 2019, in patients with AD and plaque PsO or bullous pemphigoid (BP) and plaque PsO.
• A minimum of 1 follow-up appointment was required ≥6 weeks after the initiation of dual biologic therapy for study inclusion.
• Clinical response was classified qualitatively based on changes in body surface area (BSA) involvement and Investigator’s Global Assessment (IGA) and Physician’s Global Assessment (PGA) scores.

Results

• Seven patients (Caucasian, 71%; Asian, 29%; female, 43%; mean age, 61 years; age range, 31-78 years) presented with plaque PsO and AD (n=6) or plaque PsO and BP (n=1).
• All 7 patients failed prior topical treatments, and 3 previously failed other biologic monotherapy.
• All patients completed combination TREMFYA and dupilumab (300 mg biweekly [n=5] or weekly [n=2]) treatment for 2-13 months (mean, 6.4 months; median, 6 months).
• Clinical response to combination TREMFYA and dupilumab treatment is depicted in Table: Demographic and Response Summary. Positive clinical response was defined as a reduction in BSA involvement and IGA score for dupilumab, and a reduction in BSA involvement and PGA score for TREMFYA.

Literature Search

A literature search of MEDLINE^®, EMBASE^®, BIOSIS Previews^®, and DERWENT^® (and/or other resources, including internal/external databases) was conducted on 06 December 2024.