Dupilumab-Induced Ophthalmic Disease Common in Adults With Atopic Dermatitis

Incidence of dupilumab-induced ocular surface disease (DIOSD) is common in patients with atopic dermatitis (AD), particularly those with asthma and a family history of AD, according to study findings published in Cornea.

As the first approved biologic agent for moderate to severe AD, dupilumab has demonstrated efficacy and a favorable safety profile, but it also has been associated with risk of conjunctivitis and other more severe ocular toxicities. Notably, patients with AD are prone to developing ocular surface disease, with severe AD and inflammatory conditions shown to further increase risk.

“Risk factors for DIOSD among patients with AD treated with dupilumab are unclear," noted the researchers. “Reported rates of DIOSD range from 16.4% to 31% in clinical trials and higher in short-term retrospective studies of real-world patients at 43% to 48.6%.”

They conducted a multicenter retrospective cohort study of consecutive adult outpatients treated with dupilumab for moderate to severe AD from 2017 through 2021 at Sunnybrook Health Sciences Centre and Women’s College Hospital, 2 tertiary care academic dermatology clinics in Toronto, Canada.

Participants were assessed for clinical characteristics, associated risk factors, treatment strategies, and long-term outcomes of DIOSD (N = 210; mean [SD] age, 44.2 [14.9] years; 51% female). Blepharoconjunctivitis, corneal scarring, cicatricial ectropion, burning/stinging/dryness, epiphora, pruritus, blurred vision, and photophobia were classified as DIOSD.

Stepwise multivariable logistic regression was used to assess the association between patient characteristics and development of DIOSD.

Among the study cohort, 37% (n = 78) developed DIOSD over the 52-week follow-up period. Patients with AD were shown to be almost 3 times more likely to develop DIOSD if they had a history of asthma (OR, 2.94; 95% CI, 1.26-6.87; P = .01) and just over 2.5-fold more likely if they had a family history of AD (OR, 2.58; 95% CI, 1.08-6.17; P = .03).

Vision-threatening complications, including corneal scarring and cicatricial ectropion, were found in 1% (n = 3) of patients, with the following clinical features also reported:

• Blepharoconjunctivitis (68%, n = 53)
• Burning/stinging/dryness (14%, n = 29)
• Epiphora (13%, n = 10)
• Pruritus (13%, n = 10)
• Blurred vision (3%, n = 2)
• Photophobia (1%, n = 1)

Overall, 63% of patients with DIOSD were given treatments for their ocular condition, with artificial tears (56%) and corticosteroid drops (29%) most commonly used. Dupilumab was discontinued because of DIOSD in 4% of patients with AD.

The researchers concluded that future prospective studies with an objective assessment and comparison of various interventions may be needed to help determine the underlying mechanism of DIOSD and optimal management strategies.

“Rare but vision-threatening complications, including corneal scarring and cicatricial ectropion, and disruptions in the dupilumab treatment course secondary to DIOSD may be mitigated with prompt recognition and management using topical ocular interventions,” they added.

Reference

Felfeli T, Georgakopoulos JR, Jo CE, et al. Prevalence and characteristics of dupilumab-induced ocular surface disease in adults with atopic dermatitis. Cornea. Published online October 20, 2021. doi:10.1097/ICO.0000000000002866