Dupilumab-associated ocular surface disease: presentation, management and long-term sequelae

Abstract

Objectives To determine the presenting features of ocular surface disease in patients with atopic dermatitis (AD) treated with dupilumab at a tertiary, university hospital. To establish the need for treatment of dupilumab-associated ocular surface disease and report any long-term effects on the ocular surface. Methods A retrospective analysis of consecutive patients treated with dupilumab for AD between January 2017 and August 2019 was undertaken. Data were collected on demographics, incidence and type of ocular disease features, natural history and treatment. Results A total of 50% (14/28) patients developed ocular symptoms with a mean time of onset of 6.75 (±6.1) weeks from starting dupilumab. Of these, 69% (9/13) were diagnosed with conjunctivitis associated with cicatrisation in two patients and periorbital skin changes in four. Of these nine, four had prior history of atopic keratoconjunctivitis. All were treated with topical steroids; two required additional ciclosporin drops. In all, 67% (6/9) patients went on to have on-going ocular inflammation requiring maintenance drops at a mean of 16 (±6.9) months of follow-up. All patients had improvement in their AD severity; only one patient discontinued dupilumab due to ocular side effects. Conclusion The rate of dupilumab-associated ocular surface disease was 32%. Periorbital skin changes and conjunctival cicatrisation were noted in association with conjunctivitis. Ocular surface disease improved on topical steroids and ciclosporin but 67% of patients needed on-going treatment. Close liaison with an ophthalmologist should be considered in those patients who develop conjunctivitis or have a past history of severe ocular surface disease.

A Literature Review of Real-World Effectiveness and Safety of Dupilumab for Atopic Dermatitis

“…In most patients suffering from dupilumab-associated conjunctivitis, the severity is mild to moderate ( Achten et al., 2021 ; Nahum et al., 2020 ; Nettis et al., 2020a ; Touhouche et al., 2021 ), but severe cases or those with persistent conjunctivitis have been reported ( Barnes et al., 2017 ; Li et al., 2020 ; Paulose et al., 2019 ; Popiela et al, 2021 ; Vingopoulos and Lazzaro, 2020 ). Dose adjustment or discontinuation of dupilumab is needed in certain cases ( Achten et al., 2021 ).…”

“…Keratitis ( Akinlade et al., 2019 ) is also reported. The timing of the onset of conjunctivitis after initiating dupilumab in patients with AD differed from 2 weeks to 4 months in individual reports ( Nahum et al., 2020 ; Nettis et al., 2020a ; Popiela et al, 2021 ; Uchida et al., 2020 ).…”

A pragmatic guide to choosing biologic therapies in severe asthma

“…Although this is a relatively new therapy in severe asthma, there are longer-term safety data available following its use in the treatment of atopic dermatitis. In patients with atopic dermatitis treated with dupilumab, a high incidence of conjunctivitis has been reported [ 86 ].…”

From Emollients to Biologicals: Targeting Atopic Dermatitis

“…A recent meta-analysis has confirmed that conjunctivitis is the most common adverse event, reported in 26.1% of patients [ 87 ]. The pathogenesis of these side effects is at present unknown [ 88 , 89 , 90 ]. In children, the treatment was well tolerated in the long term and the most frequent adverse reaction was nasopharyngitis [ 91 ].…”