Ocular surface disease during dupilumab treatment in patients with atopic dermatitis, is it possible to prevent it?

Pistone, Giuseppe; Tilotta, Giovanna; Gurreri, Rosario; Castelli, E.; Curiale, Salvatrice; Bongiorno, Maria Rita

doi:10.1111/jdv.16234

Cited by 5 publications

(15 citation statements)

References 7 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, Pistone et al reported no DIOSD in a series of 30 patients treated with dupilumab for 6 months. 55 Indeed, they concomitantly administered artificial tears twice daily, immediately after dupilumab initiation, which might have prevented or delayed the onset of DIOSD. Additionally, Fukuda et al showed improvement in two cases of atopic keratoconjunctivitis with giant papillae after dupilumab treatment initiation.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…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. 53,55,58,59 87 were mild forms, 32 were moderate, and five were severe. 24 out of 155 patients had previous ocular involvement 47,48,51,52,59,60 and three of them required dupilumab discontinuation.…”

Section: Case Seriesmentioning

confidence: 99%

“…48,52,60 The rest of the cases improved with topical and/ or systemic treatment. Topical therapies included: artificial tears, 46,50,52,55,57,57,59,60 hyaluronate tear substitute, 52 corticosteroid eye drops, [46][47][48][49][50][51][52][53][55][56][57]59,60 antihistaminic, 47,49,52,53,56,57,60 tacrolimus, [46][47][48]50,59,60 antibiotic, 47,50,51,57,59,60 cyclosporine, 49,[51][52][53]56 and surgery 47,50 (Table …”

Section: Case Seriesmentioning

confidence: 99%

“…From the 155 cases presented in the series, 46–60 12 discontinued dupilumab due to DIOSD severity. Most of the cases were diagnosed by an ophthalmologist (63%), 46–52,54,56,57,60 the rest being assessed by a dermatologist 53,55,58,59 . 87 were mild forms, 32 were moderate, and five were severe.…”

Section: Case Seriesmentioning

confidence: 99%

See 4 more Smart Citations

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

Neagu

Dianzani

Avallone

et al. 2022

Acad Dermatol Venereol

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

Section: Case Seriesmentioning

confidence: 99%

See 3 more Smart Citations

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

Neagu

Dianzani

Avallone

et al. 2022

Acad Dermatol Venereol

View full text Add to dashboard Cite

show abstract

Prevalence and Characteristics of Dupilumab-Induced Ocular Surface Disease in Adults With Atopic Dermatitis

Felfeli

Georgakopoulos

et al. 2021

Cornea

View full text Add to dashboard Cite

show abstract

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

et al. 2022

View full text Add to dashboard Cite

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.

show abstract

Ocular surface disease during dupilumab treatment in patients with atopic dermatitis, is it possible to prevent it?

Cited by 5 publications

References 7 publications

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

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

Prevalence and Characteristics of Dupilumab-Induced Ocular Surface Disease in Adults With Atopic Dermatitis

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

Contact Info

Product

Resources

About