Incidence of Conjunctivitis and Other Ocular Surface Disorders in Patients With Long-Term Dupilumab Use

Jo, Christine E.; Georgakopoulos, Jorge R.; Drucker, Aaron M.; Piguet, Vincent; Yeung, Jensen

doi:10.1177/1203475420929920

Cited by 7 publications

(20 citation statements)

References 5 publications

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“…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%

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: Case Seriesmentioning

confidence: 99%

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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“…Ocular side effects that have raised the most concern in patients with atopic eczema are conjunctivitis, blepharitis, keratitis and cataracts 1. Most of these adverse events occur within 4 months of starting the medication (up to 80% of cases) although in some cases, onset as late as 52 weeks has been described 15. Hyperaemia (bilateral or specifically limbal as seen in our patient) is a common presenting feature.…”

Section: Discussionmentioning

confidence: 55%

“…First, dupilumab-associated conjunctivitis (DAC), of which nonspecific conjunctivitis, papillary conjunctivitis, follicular conjunctivitis and keratoconjunctivitis have been described 13 15 16. In studies we reviewed, 36%–50% of patients presented with DAC manifesting as redness redness, itching, dryness or increased lacrimation, a gritty foreign body sensation and pain.…”

Section: Discussionmentioning

confidence: 99%

“…In studies we reviewed, 36%–50% of patients presented with DAC manifesting as redness redness, itching, dryness or increased lacrimation, a gritty foreign body sensation and pain. The patients reported onset of conjunctivitis symptoms between 1 and 8 months after starting dupilumab therapy 15. In many cases, symptoms were protracted and lasted beyond 8 months.…”

Section: Discussionmentioning

confidence: 99%

“…In many cases, symptoms were protracted and lasted beyond 8 months. Jo et al suggest that postmarketing prevalence may be as high as 50% 15. In a small fraction, dupilumab had to be stopped, either due to severity of the conjunctivitis or refractoriness to therapy.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Dupilumab-induced ocular surface disease: a primer

Reji

Haque

Goyal³

et al. 2022

BMJ Case Rep

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The management of atopic diseases has been revolutionised by precision therapies and biological drugs that target specific immune proteins. This report elucidates a unique complication from the use of the monoclonal antibody, dupilumab, that primary care providers and subspecialists need to be aware of. A patient in her 40s consulted us for severe atopic asthma, food allergy and eczema involving the face and body. She had previously failed treatments and was started on dupilumab (which binds to the interleukin-4 [IL4] receptor and inhibits both IL-4 and IL-13). She quickly achieved remission of asthma, rhinitis and eczema. Therapy was, however, complicated by severe blepharoconjunctivitis, dry eyes and periorbital dermatitis, consistent with dupilumab-induced ocular surface disease and dupilumab-associated mucin deficiency. Following aggressive treatment of ocular disease, the patient was able to continue dupilumab injections for asthma and eczema. It is presumed that dupilumab-induced cytokine imbalance results in ocular goblet cell dysfunction, mucin deficiency and ocular disease.

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