Ocular surface disease during dupilumab treatment in patients with atopic dermatitis, is it possible to prevent it?

Pistone, Giuseppe; Tilotta, Giovanna; Gurreri, Rosario; Castelli, E.; Curiale, Salvatrice; Bongiorno, Maria Rita

doi:10.1111/jdv.16234

Cited by 6 publications

(17 citation statements)

References 7 publications

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“…Furthermore, Pistone et al reported no DIOSD in a series of 30 patients treated with dupilumab for 6 months. 55 Indeed, they concomitantly administered artificial tears twice daily, immediately after dupilumab initiation, which might have prevented or delayed the onset of DIOSD. Additionally, Fukuda et al showed improvement in two cases of atopic keratoconjunctivitis with giant papillae after dupilumab treatment initiation.…”

Section: Discussionmentioning

confidence: 99%

“…From the 155 cases presented in the series, [46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] 12 discontinued dupilumab due to DIOSD severity. Most of the cases were diagnosed by an ophthalmologist (63%), [46][47][48][49][50][51][52]54,56,57,60 the rest being assessed by a dermatologist.…”

Section: Case Seriesmentioning

confidence: 99%

“…Most of the cases were diagnosed by an ophthalmologist (63%), [46][47][48][49][50][51][52]54,56,57,60 the rest being assessed by a dermatologist. 53,55,58,59 87 were mild forms, 32 were moderate, and five were severe. 24 out of 155 patients had previous ocular involvement 47,48,51,52,59,60 and three of them required dupilumab discontinuation.…”

Section: Case Seriesmentioning

confidence: 99%

“…48,52,60 The rest of the cases improved with topical and/ or systemic treatment. Topical therapies included: artificial tears, 46,50,52,55,57,57,59,60 hyaluronate tear substitute, 52 corticosteroid eye drops, [46][47][48][49][50][51][52][53][55][56][57]59,60 antihistaminic, 47,49,52,53,56,57,60 tacrolimus, [46][47][48]50,59,60 antibiotic, 47,50,51,57,59,60 cyclosporine, 49,[51][52][53]56 and surgery 47,50 (Table …”

Section: Case Seriesmentioning

confidence: 99%

“…From the 155 cases presented in the series, 46–60 12 discontinued dupilumab due to DIOSD severity. Most of the cases were diagnosed by an ophthalmologist (63%), 46–52,54,56,57,60 the rest being assessed by a dermatologist 53,55,58,59 . 87 were mild forms, 32 were moderate, and five were severe.…”

Section: Case Seriesmentioning

confidence: 99%

See 4 more Smart Citations

Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review

Neagu

Dianzani

Avallone

et al. 2022

Acad Dermatol Venereol

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Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that most frequently occurs in children, but it can also affect adults. Even though most AD cases can be managed with topical treatments, moderate‐to‐severe forms require systemic therapies. Dupilumab is the first human monoclonal antibody approved for the treatment of AD. Its action is through IL‐4 receptor alpha subunit inhibition, thus blocking IL‐4 and IL‐13 signaling pathways. It has been shown to be an effective, well‐tolerated therapy for AD, as well as for asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and eosinophilic esophagitis (EoE). However, an increasing incidence of dupilumab‐induced ocular surface disease (DIOSD) has been reported in patients treated with dupilumab, as compared to placebo. The aim of this study was to summarize scientific data regarding DIOSD in AD patients treated with dupilumab. A search of PubMed and clinicaltrials.gov databases was performed. There was no limit to study design. All AD cases were moderate‐to‐severe. DIOSD was either dermatologist‐, allergist‐, or ophthalmologist‐assessed. Evidence shows that DIOSD occurs most frequently in patients with atopic dermatitis and not in other skin conditions, neither in patients with asthma, CRSwNP, nor EoE who are on dupilumab treatment. Further studies are warranted in order to establish a causal relationship between dupilumab and ocular surface disease. Nevertheless, ophthalmological evaluations prior to dupilumab initiation can benefit AD patients with previous ocular pathology or current ocular symptomatology. Also, patch testing for ocular allergic contact dermatitis might be advantageous in patients with a history of allergic conjunctivitis. Furthermore, TARC, IgE, and circulating eosinophils levels might be important biomarkers for a baseline assessment of future candidates to dupilumab treatment. However, TARC measurements should be resumed for research purposes only.

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Section: Discussionmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

See 3 more Smart Citations

Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review

Neagu

Dianzani

Avallone

et al. 2022

Acad Dermatol Venereol

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An expert consensus on managing dupilumab-related ocular surface disorders in people with atopic dermatitis 2024

Ardern-Jones,

Brown,

Flohr

et al. 2024

British Journal of Dermatology

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Background Atopic dermatitis (AD) is the most common inflammatory skin condition which affects all ages. New therapies, including the monoclonal antibody therapy dupilumab, offer excellent efficacy. However, in clinical trials, and emphasised in real-world observations, the unexpected increased frequency of ocular adverse effects became apparent. The effectiveness of dupilumab and the unpredictability of ocular adverse effects mean that clinicians need guidance on counselling patients prior to treatment and on managing them if they arise. Objectives The British Association of Dermatologists (BAD) and Royal College of Ophthalmologists collaborated on this consensus guidance on managing dupilumab-related ocular surface disorders (DROSD). Methods A multidisciplinary group was formed of adult and paediatric dermatologists and ophthalmologists with DROSD expertise, patient representation, and BAD Clinical Standards Unit. A literature search was conducted, and the results reviewed. All recommendations were reviewed, discussed and voted on. Results The recommendations pertain to dermatology and ophthalmology management, and apply to all ages, unless otherwise stated. Importantly, initiation of dupilumab for AD should not be delayed for most eye disorders except acute new problems, e.g. infections, or potentially severe conditions, e.g. a history of corneal transplant (ophthalmology advice should be sought first). There is insufficient evidence to recommend lubricant drops prophylactically. Dermatologists should assess eye complaints to diagnose DROSD; a severity grading system is provided. DROSD management differs slightly in those aged <7 years as ocular complications may affect neuro-ocular development; therefore, irrespective of DROSD severity, this population should be referred for ophthalmology advice. In those aged ≥7 years, dermatologists should feel confident to trial treatment and reserve ophthalmology advice for severe or non-responding cases. Discussion about dupilumab withdrawal should be prompted by a significant impact on quality of life, threat to sight, or other complications. Conclusions Although dupilumab is a highly effective agent for treating AD, the risk of ocular adverse effects should not inhibit clinicians or patients from using it, but clinicians should be aware of them. If a patient develops DROSD, there are clear pathways to assess severity and offer initial management; where ineffective, dermatologists should assess the urgency and seek advice from or initiate referral to ophthalmology. While the evidence reviewed for these guidelines reflects the extensive literature on dupilumab, we believe our advice has relevance for ocular surface disorders in atopic dermatitis (AD) patients treated with tralokinumab and lebrikizumab.

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Prevalence and Characteristics of Dupilumab-Induced Ocular Surface Disease in Adults With Atopic Dermatitis

Felfeli

Georgakopoulos

et al. 2021

Cornea

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Ocular surface disease during dupilumab treatment in patients with atopic dermatitis, is it possible to prevent it?

Cited by 6 publications

References 7 publications

Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review

Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review

An expert consensus on managing dupilumab-related ocular surface disorders in people with atopic dermatitis 2024

Prevalence and Characteristics of Dupilumab-Induced Ocular Surface Disease in Adults With Atopic Dermatitis

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