Eye Complications During Dupilumab Treatment for Severe Atopic Dermatitis

Abstract

SIGNIFICANCE Dupilumab, the first biologic approved for treatment of atopic dermatitis, has demonstrated impressive clinical effect and quality of life-enhancing capacity in clinical trials. In these, dupilumab-associated conjunctivitis was reported in a minority of patients. We describe 10 patients treated with dupilumab where eye complications where common, suggesting the importance of close collaboration with an ophthalmologist. This is especially warranted among patients with severe, long-lasting atopic dermatitis and/or previous eye disease. Dupilumab, the first biologic approved for treatment of atopic dermatitis, has demonstrated significant clinical effect and quality of life-enhancing capacity in clinical trials. In these, dupilumab-associated conjunctivitis where reported in a minority of patients. The present case series describe 10 patients treated with dupilumab where eye complications were very common. We have described patient characteristics, including FLG mutations, atopic history and clinical effect of dupilumab. Nine of 10 developed eye-complications, most commonly conjunctivitis (in 7/10). Other adverse events were herpes simplex virus uveitis and varicella-zoster virus meningitis. Although our case series is small, we conclude that dupilumab is an effective treatment option in severe atopic dermatitis, but that the risk of adverse events from the eyes and recurrence of herpes virus infections should be kept in mind. Close collaboration with an ophthalmologist is recommended, especially among patients with severe, long-lasting atopic dermatitis and/or previous eye disease.

Keeping an eye on the ocular problems in dupilumab clinical trials

“…Most of the reports suggested using hyaluronic acid eye drops, topical tacrolimus eye ointment, topical corticosteroid eye drops (e.g. fluorometholone, dexamethasone, hydrocortisone), artificial tears, compounded oily ciclosporin 1% eye drops, or antibiotic–topical corticosteroid combination therapies for the treatment of conjunctivitis during dupilumab treatment . Although one study found that antihistamine eye drops and artificial tears did not alleviate conjunctivitis, a small case series of 10 patients found that using artificial tears as a preventive method 1 week before starting dupilumab treatment may have reduced the incidence of conjunctivitis .…”

“…fluorometholone, dexamethasone, hydrocortisone), artificial tears, compounded oily ciclosporin 1% eye drops, or antibiotic–topical corticosteroid combination therapies for the treatment of conjunctivitis during dupilumab treatment . Although one study found that antihistamine eye drops and artificial tears did not alleviate conjunctivitis, a small case series of 10 patients found that using artificial tears as a preventive method 1 week before starting dupilumab treatment may have reduced the incidence of conjunctivitis . Close collaboration with ophthalmologists for early and proper diagnosis and management of ocular complications in patients receiving dupilumab is also recommended …”

“…1,2,10,11 Although one study found that antihistamine eye drops and artificial tears did not alleviate conjunctivitis, 1 a small case series of 10 patients found that using artificial tears as a preventive method 1 week before starting dupilumab treatment may have reduced the incidence of conjunctivitis. 11 Close collaboration with ophthalmologists for early and proper diagnosis and management of ocular complications in patients receiving dupilumab is also recommended. 1,2,5,11…”

“…11 Close collaboration with ophthalmologists for early and proper diagnosis and management of ocular complications in patients receiving dupilumab is also recommended. 1,2,5,11…”

Treatment of refractory conjunctivitis associated to dupilumab with topical pimecrolimus applied to the eyelid skin

“…Additionally, by avoiding direct application to the ocular surface the patient's eye may not be compromised by the combination of local administration of an immune modulating agent in combination with systemic blockade of IL‐4/IL‐13 pathways. This can theoretically impair viral defenses and expose the patient to potential infectious complications such as viral keratitis and uveitis (Ivert et al, ).…”