16900 Dupilumab-associated ocular surface disease: Clinical characteristics and treatment

Abstract

Dupilumab is the first biologic medication approved for treatment of moderate to severe atopic dermatitis (AD). While few adverse events were reported in clinical trials, increased incidence of conjunctivitis with dupilumab vs placebo was consistently observed. The optimal treatment for dupilumab-associated ocular surface disease (DAOSD) has not been well established. This study aims to describe the spectrum of clinical presentations of DAOSD, and to evaluate therapeutic responses. Retrospective chart review of patients with AD and DAOSD who received ophthalmologic evaluation at Oregon Health & Science University from 2014 to 2019 yielded 29 patients (mean age 46 years; M/F: 12/17). Facial and eyelid AD were observed in 26 (90%) and 19 (66%) patients, respectively. Common ocular symptoms included irritation (n = 26, 90%), redness (n = 24, 83%), pruritus (n = 18, 62%), and tearing (n = 18, 62%). Twenty-two patients were diagnosed with conjunctivitis, 4 blepharitis, 2 keratitis, and 1 other. Topical steroids were the most commonly utilized therapy (67%), and 89% of these experienced moderate improvement or full resolution. Other therapies included artificial tears (n = 5), antihistamine drops (n = 4), lifitegrast (n = 3), tacrolimus ointment (n = 2), and cyclosporine (n = 1). Three patients discontinued dupilumab because of severe DAOSD. This study’s results suggest that patients with facial and eyelid AD may be more susceptible to DAOSD. This study also provides insight into the common ocular symptoms associated with DAOSD, which may prove useful when screening dupilumab-treated AD patients for ophthalmology referral. Very few patients discontinued dupilumab due to DAOSD, suggesting the symptoms may be controllable with ocular therapies with high efficacy rates observed with topical steroids.