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

Abstract

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.

Real-World Experience with Tralokinumab in a Patient with Recalcitrant Atopic Dermatitis: A Case Report

“…Because co-morbid eye symptoms were particularly troublesome for this patient during the spring allergy season, we chose to treat his AD with tralokinumab rather than dupilumab since it may be associated with a lower incidence of conjunctivitis compared with dupilumab. [11][12][13] Tralokinumab (Adtralza ® ) was administered as a subcutaneous injection at an initial dose of 600 mg (four 150 mg injections) followed by 300 mg (two 150 mg injections) administered every other week. Concomitant topical class II corticosteroids and pimecrolimus cream were also applied as required.…”

Real-Life Experience of Tralokinumab for the Treatment of Adult Patients with Severe Atopic Dermatitis: A Multicentric Prospective Study

“…Interestingly, no cases of new-onset tralokinumab-induced conjunctivitis were observed. Of the two patients who responded well to dupilumab but had severe conjunctivitis [ 20 ], one had no recurrence of conjunctivitis after 16 weeks of tralokinumab, and in the other patient, conjunctivitis persisted but was not aggravated. In both patients, AD remained adequately controlled.…”

Proposed management algorithm for dupilumab‐associated ocular side effects: a collaborative effort between dermatologists and ophthalmologists

“…We read with interest the study by Neagu et al, which provides a concise and comprehensive review of the reported manifestations of dupilumab-induced ocular-surface disease in patients with atopic dermatitis. 1 We have recently conducted a collaborative review involving dermatologists and ophthalmologists on dupilumab-associated ocular side effects (DOSE), in which we presented a management algorithm for the various ocular manifestations. 2 Owing to the controversy surrounding the pathomechanisms behind dupilumab's side effects, our group proposes usage of the term 'dupilumab-associated ocular side effects' to more accurately represent the nature of this entity.…”