Dupilumab and the risk of conjunctivitis and serious infection in patients with atopic dermatitis: A propensity score–matched cohort study

Schneeweiss, Maria C.; Kim, Seo Young; Wyss, Richard; Schneeweiß, Sebastian; Merola, Joseph F.

doi:10.1016/j.jaad.2020.09.084

Cited by 22 publications

(39 citation statements)

References 33 publications

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“…In addition, by comprehensively evaluating ocular surface disorders, including dry eye, and by attempting to differentiate atopic and other forms of conjunctivitis, our study provides a more granular analysis of ocular surface disorders compared with those of prior cohort studies. 2,6 The findings of this study should be interpreted in the context of the study design. because concerns regarding dupilumab-associated ocular surface disorders have been present since the initial clinical trials, it is possible that clinicians would be more likely to evaluate for and code ocular surface disorders among patients receiving dupilumab than among those receiving methotrexate.…”

Section: Discussionmentioning

confidence: 94%

“…A cohort study also identified an association between dupilumab use for atopic dermatitis and conjunctivitis; however, it did not evaluate other ocular surface disorders such as dry eye or clinical management. 6 Several small case series have also described ocular surface disorders among 10%-40% of patients being treated with dupilumab. 7 , 8 , 9 , 10 In contrast, in the phase III trials of dupilumab for asthma and chronic rhinosinusitis with nasal polyps, an increased risk for conjunctivitis was not observed.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, most of these studies focused on conjunctivitis without considering other ocular surface disorders that may be associated with dupilumab such as dry eye, and few examined treatment use. 2 , 6 , 7 , 11 , 12 The purpose of this study was to comprehensively evaluate the incidence of ocular surface disorders (ie, conjunctivitis and dry eye) among a large, population-based cohort of patients being treated with dupilumab in routine clinical practice, as well as to examine the use of ophthalmic treatments and the frequency of dupilumab discontinuation.…”

Section: Introductionmentioning

confidence: 99%

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Encounters and medication use for ocular surface disorders among patients treated with dupilumab: A cohort study

et al. 2021

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Background: Although dupilumab has been associated with the development of conjunctivitis, little is known about other ocular surface disorders such as dry eye and how these side effects are managed.Objective: To evaluate the incidence and management of ocular surface disorders, including dry eye and conjunctivitis, among patients treated with dupilumab.Methods: Using US claims data, we evaluated the incidence of encounters for ocular surface disorders among patients treated with dupilumab. Secondary outcomes included ophthalmic medication use. A propensity score matched, active-comparator, new-user cohort design was used to compare the incidence of ocular surface disorders between those starting dupilumab versus methotrexate.Results: Among those with a history of atopic dermatitis, encounters for ocular surface disorders were more common in the 6 months after starting dupilumab than in the 6 months prior (11.7% versus 8.7%, P \ .001); 59.7% of those with a new ocular surface disorder diagnosis filled a prescription for an ophthalmic medication. The incidence of ocular surface disorders was higher among those treated with dupilumab than that in those treated with methotrexate (odds ratio 1.64; 95% confidence interval 1.17-2.30).Limitations: Observational design.Conclusions: Dupilumab use for atopic dermatitis was associated with an increased risk of ocular surface disorders. Most patients who developed an ocular surface disorder received a prescription for an ophthalmic medication. ( JAAD Int 2021;4:j-j.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Encounters and medication use for ocular surface disorders among patients treated with dupilumab: A cohort study

et al. 2021

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“…In 2018, the National Institute for Health and Care Excellence (NICE) approved the use of dupilumab in patients with moderate-severe AD who had not responded to at least one systemic therapy and it was later approved for the use in children over the age of 12 years. [11][12][13][14] The most frequent adverse effects of dupilumab are injection site reactions and non-infectious conjunctivitis, which rarely necessitates treatment cessation. Risk of serious infection with dupilumab appears low and biologics targeting the Th2 pathway do not significantly increase bacterial or opportunistic infections.…”

Section: Advances In Treatmentmentioning

confidence: 99%

“…Dupilumab should be avoided in patients at risk of helminth infections. 14,15 Tralokinumab (anti-IL-13) has nearly completed phase III clinical trials and early reports have shown that, as well as dupilumab, alternative strategies for Th2 inhibition by direct anti-cytokine monoclonal antibody therapy with anti-IL-13 are likely to be effective .…”

Section: Advances In Treatmentmentioning

confidence: 99%

Advances in atopic dermatitis

Plant

Ardern‐Jones

2021

Clinical Medicine

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Atopic dermatitis (AD) is a common inflammatory skin disease characterised by itch and is responsible for significant reduction in quality of life. While AD primarily arises in those under the age of 2 years, it is frequently persistent into adulthood. Recognition of AD is important for the general physician, especially to distinguish causes of acute flares that may present in any medical setting, such as eczema herpeticum and associated allergic reactions. While, to date, treatments have largely focused on broad spectrum immunomodulation with corticosteroids or systemic therapies (such as ciclosporin and methotrexate), increased knowledge in the pathophysiology of the disease has recently led to the expansion of treatment options available for those suffering with AD, and the new drugs on the horizon promise a previously unimagined potential for effective and safe treatment.

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Association of Self-reported High-Risk Allergy History With Allergy Symptoms After COVID-19 Vaccination

Robinson

Patel

et al. 2021

JAMA Netw Open

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IMPORTANCE Allergic history in individuals with confirmed anaphylaxis to a messenger RNA (mRNA) COVID-19 vaccine is common. However, the risk factors for allergy symptoms after receiving the vaccine are unknown. OBJECTIVETo assess the association between self-reported history of high-risk allergy and selfreported allergic reactions after mRNA COVID-19 vaccination of health care employees. DESIGN, SETTING, AND PARTICIPANTSThis cohort study obtained demographic, medical, and vaccine administration data of employees of Mass General Brigham from the institutional electronic health record. Employees who received at least 1 dose of an mRNA COVID-19 vaccine between December 14, 2020, and February 1, 2021, and who completed at least 1 postvaccination symptom survey in the 3 days after vaccination were included.EXPOSURES Self-reported history of high-risk allergy, defined as a previous severe allergic reaction to a vaccine, an injectable medication, or other allergen. MAIN OUTCOMES AND MEASURESThe primary outcome was 1 or more self-reported allergic reactions in the first 3 days after dose 1 or dose 2 of an mRNA COVID-19 vaccine. Multivariable log binomial regression was used to assess the association between allergic reactions and high-risk allergy status. RESULTS A total of 52 998 health care employees (mean [SD] age, 42 [14] years; 38 167 women [72.0%]) were included in the cohort, of whom 51 706 (97.6%) received 2 doses of an mRNA COVID-19 vaccine and 474 (0.9%) reported a history of high-risk allergy. Individuals with vs without a history of high-risk allergy reported more allergic reactions after receiving dose 1 or 2 of the vaccine (11.6% [n = 55] vs 4.7% [n = 2461]). In the adjusted model, a history of high-risk allergy was associated with an increased risk of allergic reactions (adjusted relative risk [aRR], 2.46; 95% CI, 1.92-3.16), with risk being highest for hives (aRR, 3.81; 95% CI,) and angioedema (aRR, 4.36; 95% CI,.CONCLUSIONS AND RELEVANCE This cohort study found that self-reported history of high-risk allergy was associated with an increased risk of self-reported allergic reactions within 3 days of mRNA COVID-19 vaccination. However, reported allergy symptoms did not impede the completion of the 2-dose vaccine protocol among a cohort of eligible health care employees, supporting the overall safety of mRNA COVID-19 vaccine.

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Dupilumab and the risk of conjunctivitis and serious infection in patients with atopic dermatitis: A propensity score–matched cohort study

Cited by 22 publications

References 33 publications

Encounters and medication use for ocular surface disorders among patients treated with dupilumab: A cohort study

Encounters and medication use for ocular surface disorders among patients treated with dupilumab: A cohort study

Advances in atopic dermatitis

Association of Self-reported High-Risk Allergy History With Allergy Symptoms After COVID-19 Vaccination

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