Dupilumab‐associated ocular surface disease: An interdisciplinary decision framework for prescribers in the Australian setting

Abstract

Background/Objectives Dupilumab‐associated ocular surface disease (DAOSD) is of particular relevance in patients with atopic dermatitis (AD). Guidance on DAOSD assessment and management in the Australian setting is needed to reduce its impact and minimise disruption to treatment. Methods A systematic review of the literature was undertaken to identify data pertaining to the incidence, pathophysiology, risk factors and management of DAOSD. A critical review of this literature was used to inform a decision framework for dupilumab‐prescribers and develop a graded severity scoring tool to guide appropriate management options. Results DAOSD typically emerges within 4 months of commencing dupilumab and the occurrence of new events diminishes over time. The reported incidence varies widely depending on the nature and source of the data: 8.6–22.1% (clinical trials programme), 0.5–70% (real‐world data; differences in study size, duration of follow‐up, ophthalmologist intervention, use of prophylaxis). Occurrence increases with AD severity and in patients with prior history of ocular disease; pathophysiology is still to be fully characterised. Management options have evolved over time and include lubricants/artificial tears, corticosteroids, calcineurin inhibitors, antihistamines, anti‐inflammatory agents and antimicrobial agents. Current therapies aim to resolve symptoms or reduce severity to levels sufficiently tolerable to enable continuation of dupilumab therapy. Conclusions Recommendations for DAOSD assessment and management include identification of high‐risk patients, vigilance for red flags (keratoconus, herpetic and bacterial keratitis), regular assessment of symptom severity (before and during dupilumab therapy), conservative management of mild DAOSD by the prescribing physician and ophthalmologist referral for collaborative care of moderate–severe DAOSD and high‐risk patients.

Ocular surface disease in moderate‐to‐severe atopic dermatitis patients and the effect of biological therapy

“…14 However, as Foley et al pointed out, the UTOPIA score may not be a suitable tool for the dermatologist, as this examination is performed with a slit lamp and requires ophthalmic knowledge and experience. 15 This emphasizes the need to learn more about the associations between OSD and dermatological, ophthalmological, and clinical factors to identify which patients need an ophthalmic examination and ophthalmological treatment.…”

Ocular Surface Adverse Events are not Associated with Dupilumab use in Nasal Polyp Treatment

“…8 Emerging data from real-life studies on the use of dupilumab for atopic dermatitis (AD) suggests that conjunctivitis, blepharitis, keratitis, eye pruritus, and dry eye are commonly reported AEs. [13][14][15][16][17][18][19][20][21] This has led to the acknowledgment of dupilumab-associated ocular surface reactions (DA-OSRs) as a distinct category of AEs. DA-OSRs vary in their reported incidence and disease severity.…”