Dupilumab use in Severe Atopic Dermatitis may induce two types of Ocular Surface Diseases

A team of researchers from Lille Catholic Hospitals, Lille Catholic University, Lille, France reported 10 cases of conjunctivitis in atopic dermatitis (AD) patients treated with dupilumab from November 2017 to November 2018 in our institution, who were referred to the ophthalmology department for diagnosis and management of conjunctivitis. The authors also described ocular surface findings in these patients before the first injection of dupilumab.

They observed that:

• During the first 6 months post initiation ofdupilumab, incidence of conjunctivitis was 27% (5/18) in patients treated from November 2017 to April 2018 who had not had ocular examination previously.
• This rate dropped to 12% (3/25) after systematic ophthalmological referral before initiation of dupilumab. Patients who developed conjunctivitis had mean SCORAD score (Scoring Atopic Dermatitis) of 60.4 ± 20 (35–88) and mean EASI score (Eczema Area and Severity Index) of 37 ± 17 (14.6–56).
• Mean age was 36 years (20–51). Most patients had a long history of AD (> 10 years).
• Mean delay of ocular surface inflammation was 3.5 months, ranging from 1 to 8 months.
• One patient had to discontinue dupilumab because of severe follicular conjunctivitis.
• Two clinical patterns of ocular surface diseases were observed: a mild non-specific conjunctivitis with dry eyes, which improved with warm compresses and artificial tears without any recurrence; and a severe dupilumab-induced follicular conjunctivitis without keratitis, which required specific ophthalmological management.

Thus, the authors concluded that the underlying mechanism for the development of conjunctivitis seems to be inflammatory and specific to Atopic Dermatitis (AD) since this side effect was not noted in patients with asthma or nasal polyposis on dupilumab.Reference:

The study Ocular Surface Diseases Induced by Dupilumab in Severe Atopic Dermatitis by Adrien Maudinet, et al. was published in the Ophthalmology and Therapy

doi: 10.1007/s40123-019-0191-9