Dupilumab Ocular Surface Disease More Common in Atopic Dermatitis

Anatomy of human eye, perspective.
Data suggest that individuals with atopic dermatitis may have unique ocular properties that are responsible for the development of ocular surface disease.

Dupilumab ocular surface disease (DOSD) occurs at a much lower rate in patients who are treated for a skin disease other than atopic dermatitis (AD), according to a study published in the Journal of the American Academy of Dermatology.

In this retrospective chart review, researchers compared the frequency of DOSD in patients with AD (n=85) to patients with other cutaneous diseases (n=26). The other conditions included bullous pemphigoid (n=1); chronic actinic dermatitis (n=2); chronic idiopathic urticaria (n=1); cutaneous T cell lymphoma (n=1); dermal hypersensitivity, dermatitis of Immunoscenescence (n=1 each); dyshidrotic eczema (n=11); erythema annulare centrifugum (n=1); palmoplantar psoriasis (n=1); prurigo nodularis (n=2); psoriasiform dermatitis (n=3); and Wells syndrome (n=1).

Patients were seen at UConn Dermatology Associates or the Connecticut VA between April 2016 and April 2019 and were excluded if they did not have a dermatology follow-up after initiating treatment with dupilumab, reported noncompliance with dupilumab, and/or were receiving dupilumab for non-dermatologic indications.

Of the 85 patients receiving dupilumab for AD, 23 developed DOSD, compared with only 1 patient who received dupilumab for another cutaneous indication (odds ratio [OR] 9.2742; 95% confidence interval [CI], 1.1876–72.4237; P <.01). Two of the 24 patients receiving dupilumab for a dermatologic indication other than AD discontinued the medication because they experienced intolerable ocular symptoms.

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This study was limited by its retrospective nature, misclassification bias, and use of data from several clinicians.

These findings are consistent with previous findings that DOSD does not occur in individuals who received dupilumab for asthma. The researchers suggested that “individuals with AD may have unique ocular properties that are responsible for the development of (ocular surface disease) in the context of IL-13 inhibition as OSD has also been reported in Phase II AD trials of an IL-13 inhibitor.”

Researchers further postulated a potential explanation based on a series of conjunctival biopsies from patients with DOSD that found decreased density of intraepithelial goblet cells, suggesting that DOSD occurs secondary to tear film alteration and subsequent conjunctival irritation. It is important to understand the potential risk for OSD as dupilumab is increasingly used for cutaneous diseases other than AD.

Disclosure: One author declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of author’s disclosures.

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Waldman RA, DeWane ME, Sloan SB, King B, Grant-Kels JM. Dupilumab ocular surface disease occurs predominantly in patients receiving dupilumab for atopic dermatitis: a multi-institution retrospective chart review [published online July 17, 2019]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2019.07.031