Systematic Review and Analysis of Dupilumab Use on the Stage of Mycosis Fungoides Presentation

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To investigate the impact of dupilumab use on the stage of mycosis fungoides presentation, we performed and compared two systematic reviews - one for patients with MF/CTCL and history of dupilumab intervention and one for population studies of MF. In this systematic assessment of the literature, dupilumab treatment was associated with a higher-stage MF diagnosis even after adjusting for age and sex. The following supplemental materials include tables of the search strategies, patient characteristics, references for the reviewed articles, and figures of the PRISMA diagrams for both systematic reviews.

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We consulted with a trained librarian (B.A.) from the University of California, Davis School of Medicine. A systematic review was conducted searching PubMed, Embase, and Web of Science for dupilumab intervention and outcome of MF or CTCL. The inclusion criteria of the studies allowed for published manuscripts in English with any study design from database inception to June 18, 2024. Eligible studies involved intervention with dupilumab treatment, participants of all ages treated for skin symptoms, and any reported outcomes of confirmed diagnosis and stage of MF or CTCL. Animal studies, non-English literature, systematic reviews, and studies with unclear MF or CTCL diagnosis and staging were excluded. Another systematic review was also performed for cohort studies characterizing stage at MF or CTCL presentation in the general population searching PubMed, Embase, and Web of Science. Inclusion criteria for this review was any study design consisting of published manuscripts in English from database inception to September 13, 2024. Eligible studies consisted of a population greater than or equal to ten subjects, a confirmed diagnosis and stage of MF or CTCL, no limitation with age, geographic location, or intervention. Any non-English article with dupilumab intervention or a history of unclear diagnosis of MF or CTCL were excluded. The extensive search strategies for both the systematic reviews can be found in Supplementary Tables 1 and 2. Two independent reviewers (C.L. and N.L.) completed the title and abstract screening using COVIDENCE online systematic review software. The reviewers were blinded by each other’s decisions and discrepancies were resolved through a consensus. For the systematic review of dupilumab intervention and MF, reviewers extracted data regarding author (year), sex, study design, age, indication for initiation of dupilumab therapy, other immunosuppressive treatments, sample size, time from initiation of dupilumab to diagnosis of CTCL, and stage of CTCL on diagnosis. Stage at diagnosis of CTCL, author (year), age, sex, and sample size were collected for the review of MF population studies.

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