High Risk of Ocular Surface Disease in Children with Atopic Dermatitis on Dupilumab, Study Finds

The researchers reported that approximately one-third of pediatric atopic dermatitis patients receiving dupilumab developed DAOSD, with tarsal conjunctivitis present in all cases requiring treatment. They further noted that pruritus (75.0%), redness (72.2%), and tearing (58.3%) were the most commonly reported symptoms. Additionally, patients with elevated serum IgE levels (≥ 3000 kU/L) had a significantly higher risk of developing DAOSD (OR 4.65). Among those affected, 30% required anti-inflammatory therapy for symptom management.

While Dupilumab-Associated Ocular Surface Disease is a frequently observed side effect in pediatric atopic dermatitis patients receiving dupilumab, long-term real-world safety data remains limited. To address this gap, Marlies de Graaf, Department of Dermatology and Allergology, National Expertise Center for Atopic Dermatitis, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands, and colleagues examined the incidence of DAOSD in pediatric AD patients undergoing dupilumab treatment while also identifying potential risk factors associated with its development.

For this purpose, the researchers conducted a prospective study on pediatric AD patients (3–17 years) receiving dupilumab, assessing ocular symptoms every 4–12 weeks. Initial DAOSD management included lubricating and antihistamine eye drops or tacrolimus ointment, while persistent cases required ocular anti-inflammatory therapy and ophthalmological evaluation. Univariable and multivariable regression analyses identified predictors for DAOSD development.

Key Findings:

• The study included 104 pediatric AD patients (mean age: 11.7 ± 4.0 years) with a median follow-up of 70.5 weeks.
• 34.6% (36/104) of patients developed DAOSD, with 30.6% (11/36) requiring ocular anti-inflammatory therapy.
• DAOSD occurrence was not influenced by age or pre-existing allergic conjunctivitis.
• The most common ocular symptoms were pruritus (75.0%), redness (72.2%), and tearing (58.3%).
• Tarsal conjunctivitis was present in all patients requiring ocular anti-inflammatory therapy.
• Baseline serum IgE levels ≥ 3000 kU/L were significantly associated with DAOSD development (OR 4.65).
• 3.8% (4/104) of patients discontinued dupilumab due to DAOSD.

"The long-term, real-world study finds that 34.6% of pediatric AD patients on dupilumab develop DAOSD, with elevated baseline serum IgE (≥ 3000 kU/L) as a potential predictor," the researchers wrote.

"The high incidence highlights the need for careful monitoring of ocular symptoms, especially in young children who may struggle to report them, risking delayed diagnosis," they concluded.

Reference:

A. Zuithoff, N. P. Dupilumab-Associated Ocular Surface Disease in Paediatric Atopic Dermatitis Patients: Results From the BioDay Registry. Clinical & Experimental Allergy. https://doi.org/10.1111/cea.70025