Work

Systematic review and analysis of dupilumab, cyclosporine, and upadactinib use on the stage of mycosis fungoides presentation

Year: 2026

Type: review

Abstract: Background Recent literature reports cutaneous T-cell lymphoma development, commonly mycosis fungoides (MF), following biologic or immunosuppressant use for chronic skin disease. It remains unclear whether patients were initially misdiagnosed or if treatment contributed to MF progression. Methods We performed four systematic reviews of MF stage at presentation for the general population, as well as patients with MF following dupilumab, cyclosporine, or upadacitinib use. Statistical tests and models were weighted by manuscript sample size. Chi-square and a two-sample t-tests assessed MF stage at diagnosis, age, and sex. A weighted multivariable linear regression model assessed the effects of treatment, age, and sex on MF stage. Results Using stage gradations IA, IB, IIA, IIB, IIIA, IIIB, IVA, IVB, patients treated with dupilumab (n=94), cyclosporine (n=25), or upadacitinib (n=7) had 1.28, 2.45, and 2.39, respectively, higher MF stage at diagnosis (n=10093), adjusting for age and sex (p-value<0.0001). Conclusions Treatment with dupilumab, cyclosporine, or upadacitinib was associated with a higher-stage MF diagnosis. We were limited by the existing literature and retrospective nature of data collection. Our findings highlight the need for additional studies in investigating the underlying mechanism of these observations.

Source: JAAD reviews.

DOI: 10.1016/j.jdrv.2026.06.009