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

Felfeli, Tina; Georgakopoulos, Jorge R.; Jo, Christine E.; Piguet, Vincent; Drucker, Aaron M.; Yeung, Jensen; Chan, Clara C.

doi:10.1097/ico.0000000000002866

Cited by 9 publications

(11 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Clinical trials and daily practice studies of dupilumab‐treated AD patients reported DAOSD incidences of up to 34%, which is more or less comparable to our incidence 2–4 . The most frequently observed ophthalmological characteristics were conjunctivitis (both bulbar and tarsal), blepharitis and Meibomian gland dysfunction, both before and during dupilumab treatment, which is partly in line with previous literature 16–18 . However, the majority of studies regarding DAOSD are not based on ophthalmological data, but on patient‐reported diagnosis.…”

Section: Discussionsupporting

confidence: 90%

Dupilumab‐associated ocular surface disease in atopic dermatitis patients: Clinical characteristics, ophthalmic treatment response and conjunctival goblet cell analysis

Achten

Thijs

Wal

et al. 2023

Allergy

View full text Add to dashboard Cite

Background Dupilumab‐associated ocular surface disease (DAOSD) is frequently reported as side effect in atopic dermatitis (AD) patients. Therefore, the aim of this study was to investigate the frequency and severity of DAOSD, ophthalmic treatment response and to learn more about the effect of dupilumab on conjunctival goblet cells (GC). Methods This prospective study included dupilumab‐treated AD patients between February 2020 and June 2022 from the University Medical Centre Utrecht. Patients were examined by an ophthalmologist and a dermatologist before start (baseline), and after 4 and 28 weeks of dupilumab treatment. Ophthalmological examination was assessed by the Utrecht Ophthalmic Inflammatory and Allergic disease (UTOPIA) score. DAOSD was defined as an increase in UTOPIA score of ≥3 points from baseline. To quantify conjunctival GCs and to investigate the percentage of Cytokeratin 19 (CK19)‐CD45‐Mucin 5 AC (MUC5AC)+ cells, conjunctival impression cytology samples were analysed. Results Ocular surface disease (OSD) was present in 91.3% (n = 63/69) patients at baseline. DAOSD was observed in 28.9% (n = 20/69) patients, in whom GC numbers remained stable and the percentage of CK19‐CD45‐MUC5AC+ cells decreased at onset of DAOSD compared with baseline. After 28 weeks of dupilumab treatment, DAOSD was seen in 14.5% (n = 10/69) patients. Of the 85.5% (n = 59/69) patients without DAOSD or with controlled DAOSD at Week 28, 40.7% (n = 24/59) patients received anti‐inflammatory ophthalmic drugs. Conclusions Ocular surface disease is common in moderate‐to‐severe AD patients before starting dupilumab. During treatment with dupilumab DAOSD severity improves with early ophthalmic treatment. The decrease in percentage of CK19‐CD45‐MUC5AC+ cells during dupilumab treatment suggests an impairment of the GC function due to dupilumab treatment.

show abstract

Section: Discussionsupporting

confidence: 90%

Dupilumab‐associated ocular surface disease in atopic dermatitis patients: Clinical characteristics, ophthalmic treatment response and conjunctival goblet cell analysis

Achten

Thijs

Wal

et al. 2023

Allergy

View full text Add to dashboard Cite

show abstract

“…The clinical findings of DIOSD in our cases were characterized by severe conjunctival hyperemia with conjunctival swelling in the palpebral and bulbar conjunctiva, which was the same as previously reported [ 4 , 5 , 10 , 11 ]. However, these conjunctival findings are not specific to DIOSD, and the differential diagnosis of acute exacerbation of AKC is difficult.…”

Section: Discussionsupporting

confidence: 88%

“…Dupilumab-induced blepharitis and conjunctivitis have a wide variety of clinical phenotypes including moderate to severe conjunctivitis [ 4 ], follicular conjunctivitis [ 5 ], giant papillary conjunctivitis [ 6 , 7 ], blepharoconjunctivitis [ 8 ], cicatrizing conjunctivitis [ 9 ], and corneal limbitis [ 5 ]. Therefore, ocular surface diseases that occur during dupilumab treatment have been names dupilumab-induced ocular surface diseases (DIOSDs) [ 10 , 11 ]. However, the detailed pathogenesis of DIOSD is not yet fully understood.…”

Section: Introductionmentioning

confidence: 99%

Two cases of dupilumab-associated conjunctivitis with high expression of IL-8 mRNA on the ocular surface: a case report

Adachi

Shoji

Hirota

et al. 2022

Allergy Asthma Clin Immunol

View full text Add to dashboard Cite

Background Dupilumab-induced ocular surface disease (DIOSD) has been reported in patients with atopic dermatitis treated with dupilumab, and has been recognized as an adverse event of dupilumab. Our objective was to describe two cases of DIOSD with alterations in eotaxin-2 and interleukin (IL)-8 messenger ribonucleic acid (mRNA) expression on the ocular surface. Case presentation In the ocular surface test, specimens were collected from the patient's ocular surface, and eotaxin-2 and IL-8 mRNA levels in the specimens were measured using real-time polymerase chain reaction. The clinical score of ocular surface findings was quantified using a 5-5-5 exacerbation grading scale for allergic conjunctivitis. The first case was of a 27-year-old man who developed DIOSD 3 months after starting treatment with dupilumab injection for atopic dermatitis. After 5 weeks of topical instillation of tacrolimus ophthalmic suspension, the clinical score of ocular surface findings improved and IL-8 and eotaxin-2 mRNA expression levels gradually decreased. The second patient was a 55-year-old man who developed DIOSD 11 weeks after the start of treatment with dupilumab injection for atopic dermatitis. Four weeks after starting ophthalmological treatment with tacrolimus ophthalmic suspension, his clinical scores on ocular surface findings improved and IL-8 mRNA expression levels decreased. The ocular surface test in this case revealed increased expression levels of IL-8 mRNA on the ocular surface at the onset of DIOSD, which decreased with the improvement of objective findings. Conclusions DIOSD, which has been successfully treated with tacrolimus ophthalmic suspension, may involve IL-8-related inflammation in addition to type 2 inflammation.

show abstract

“…We identified clinical findings of DAOSD that are uncommon in the literature. 23 A significant proportion of our patients presented with limbal nodules, sometimes accompanied by Horner-Trantas-like dots. This form of limbal inflammation may be seen in the limbal form of vernal keratoconjunctivitis, but it is very rarely encountered in our geographic area and is also less common in adults.…”

Section: Discussionmentioning

confidence: 74%

“…The largest cohort included 210 patients with AD and examined the onset of DAOSD in general. 23 They identified 78 patients as having developed DAOSD, among whom 15 patients were seen in ophthalmology. Other large case series included 10–23 patients and described the clinical manifestations of DAOSD as being predominantly characterised by eyelid dermatitis, blepharitis, limbal inflammation and conjunctivitis.…”

Section: Discussionmentioning

confidence: 99%

Characterising the chronicity of dupilumab-associated ocular surface disease: an analysis of a retrospective case series

Hébert

You

et al. 2022

BMJ Open Ophth

View full text Add to dashboard Cite

Background/aimsTo describe the clinical presentation and treatment response of dupilumab-associated ocular surface disease (DAOSD).MethodsThis is a retrospective case series of atopic dermatitis patients with DAOSD treated with dupilumab. All consecutive patients with atopic dermatitis referred by dermatologists for suspicion of DAOSD between May 2018 and June 2020 were systemically assessed by a single ophthalmologist. Presenting signs of DAOSD, duration of treatment and associated response are described.ResultsTwenty-eight patients had DAOSD during the study period. Average age was 45.6±14.8 years and 13 (46%) were female. Average follow-up was 15±10 months. Most presentations consisted in diffuse, inflammatory conjunctivitis (n=19, 68%). Other signs included peripheral corneal infiltrates (n=7, 25%), limbal nodules (n=7, 25%) and dry eye syndrome (n=6, 21%). To control ocular symptoms, tapering of corticosteroid eyedrops was slow: taper duration of strong and mild corticosteroid eyedrops averaged 10±8 weeks and 49±34 weeks, respectively. Four patients (14%) required an increase of corticosteroid eyedrops during taper due to clinical deterioration. Corticosteroid eyedrops were still required at final follow-up among 10 patients (36%). Dupilumab was temporarily stopped in 3 patients (11%), one of which did not wish to resume dupilumab for unrelated reasons. Symptomatic improvement and/or complete resolution was achieved in 25/26 patients at follow-up (96%) with empirical treatment.ConclusionsDAOSD may follow the course of a chronic illness. Long-term corticosteroid eyedrops were required in many patients and when taper was possible, this was done after a prolonged treatment duration. Most patients’ ocular symptoms could be controlled, allowing dupilumab continuation.

show abstract

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

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 9 publications

References 23 publications

Dupilumab‐associated ocular surface disease in atopic dermatitis patients: Clinical characteristics, ophthalmic treatment response and conjunctival goblet cell analysis

Dupilumab‐associated ocular surface disease in atopic dermatitis patients: Clinical characteristics, ophthalmic treatment response and conjunctival goblet cell analysis

Two cases of dupilumab-associated conjunctivitis with high expression of IL-8 mRNA on the ocular surface: a case report

Characterising the chronicity of dupilumab-associated ocular surface disease: an analysis of a retrospective case series

Contact Info

Product

Resources

About