TREATMENT OF DUPILUMAB-ASSOCIATED KERATOCONJUNCTIVITIS

Abstract

<h3>Introduction</h3> Dupilumab is a monoclonal antibody that inhibits interleukin (IL)-4 and (IL)-13 signaling and is an effective treatment option in moderate-to-severe atopic dermatitis (AD). Conjunctivitis is one of the more common side effects of dupilumab, and higher rates (4.4% up to 55.8%) are seen in moderate to severe AD. <h3>Case Description</h3> The patient is a 7-year-old male with history of severe atopic dermatitis (with filaggrin variant), eosinophilic esophagitis, asthma, and food allergies who was started on Dupilumab for treatment of atopic dermatitis and had great improvement. Six months into treatment, he developed eye itching, redness and photosensitivity that did not respond to artificial tears, ketotifen or olopatadine eye drops. He was referred to ophthalmology and was noted to have diffuse conjunctival injection and nasal serous chemosis in both eyes. After initiation of olopatadine daily and prednisolone 1% QID, symptoms dramatically improved. The prednisolone was tapered off, but he had a flare with the next Dupilumab injection, which also required prednisolone treatment. Fluorometholone 0.1% was provided to treat flares associated with infusions. He has been maintained on a regimen of olopatadine daily and fluorometholone 0.1% eye drops twice a day for five days around the time of dupilumab injections. After six months, he has not had intraocular pressure elevation, conjunctival thickening, corneal involvement or other complication. Dupilumab discontinuation or dose adjustment has not been needed. <h3>Discussion</h3> Patients who develop conjunctivitis with dupilumab can be successfully managed with guidance from an ophthalmologist.