A LARGE USA cohort study has found an increased risk of lymphoma among patients with asthma treated with dupilumab, particularly T and natural killer (NK) cell lymphomas.
While dupilumab is widely used to treat asthma and atopic conditions, concerns about malignancy risk, raised by recent findings in atopic dermatitis, prompted a focused investigation in an asthma population. This population-based cohort study examined over 14,000 patients with asthma treated with dupilumab and more than 730,000 matched controls treated with inhaled corticosteroids (ICS) and long-acting beta agonists (LABA) from 2018–2024. Propensity score matching was used to balance baseline variables between the two groups, with the primary outcome being incidence of lymphoma and secondary outcomes including other malignancies and all-cause mortality.
After matching, 54 new cases of lymphoma were recorded in the dupilumab group versus 43 in the ICS/LABA group, translating to a hazard ratio (HR) of 1.79 (95% CI: 1.19–2.71). Notably, the risk for T and NK cell lymphomas was significantly elevated (HR: 4.58, 95% CI: 1.82–11.53). Other cancers showed no significant differences between groups. Paradoxically, dupilumab-treated patients had lower all-cause mortality (HR: 0.65, 95% CI: 0.57–0.74), suggesting broader clinical benefit despite the oncological signal.
These results raise important questions about the immunomodulatory mechanisms of dupilumab and emphasise the need for long-term pharmacovigilance. The mortality benefit may justify continued use, but clinicians should monitor for lymphoproliferative disorders in susceptible individuals.
Reference
Sheng-Kai Ma K et al. Dupilumab and lymphoma risk among patients with asthma: a population-based cohort study. Eur Respir J. 2025; DOI: 10.1183/13993003.00139-2025.
