Conjunctivitis occurring in atopic dermatitis patients treated with dupilumab–clinical characteristics and treatment

Lifitegrast add-on treatment for dupilumab-induced ocular surface disease (DIOSD): A novel case report

“…Our patient, for example, displayed conjunctivitis, blepharitis, and dry eye. There is little published information regarding treatment or prognosis of DIOSD, although a small case series found partial responsiveness to low-potency steroid eye drops, and another case report showed resolution when dupilumab was discontinued 2, 3. It is currently unknown if there are potential long-term sequelae from DIOSD, although as in our case, there have been no reports of impaired visual acuity or other serious or permanent damage to the eye from DIOSD.…”

Keeping an eye on the ocular problems in dupilumab clinical trials

“…Dupilumab is a monoclonal antibody that blocks the shared receptor component for interleukin (IL)‐4 and IL‐13, thus inhibiting the signalling of both IL‐4 and IL‐13, and is approved for inadequately controlled moderate‐to‐severe atopic dermatitis (AD) . However, an increased incidence of conjunctivitis has been detected in patients who received dupilumab compared with those who received placebo.…”

“…However, IL‐17 is decreased in dupilumab‐treated patients and the disease course of conjunctivitis is too short in comparison with ocular rosacea . Dupilumab may increase OX40 ligand activity, which is involved in atopic keratoconjunctivitis . An increase in eosinophil counts after dupilumab administration might be another mechanism, as eosinophilic factors are elevated in the tears of patients with allergic conjunctivitis .…”

“…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 …”