Conjunctivitis in dupilumab clinical trials

Area of Science:

• Immunology
• Dermatology
• Ophthalmology

Background:

• Dupilumab targets interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways, approved for moderate-to-severe atopic dermatitis (AD) and asthma.
• Clinical trials have indicated an increased incidence of conjunctivitis with dupilumab use in AD patients compared to placebo.

Purpose of the Study:

• To further investigate the occurrence and identify risk factors for conjunctivitis in dupilumab clinical trials across various conditions.

Main Methods:

• Analysis of randomized placebo-controlled trials involving dupilumab in atopic dermatitis (AD), asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), and eosinophilic esophagitis (EoE).
• Evaluation of conjunctivitis incidence, baseline disease severity, and prior medical history as potential risk factors.

Main Results:

• Higher conjunctivitis incidence was observed in dupilumab-treated AD patients versus placebo, associated with greater AD severity and prior conjunctivitis history.
• Conjunctivitis cases were predominantly mild to moderate, with most resolving during treatment; rare discontinuations occurred due to ocular issues.
• In asthma, CRSwNP, and EoE trials, conjunctivitis incidence was low and comparable between dupilumab and placebo groups.

Conclusions:

• Conjunctivitis is more frequent with dupilumab in AD trials, linked to disease severity and history, but generally manageable.
• Dupilumab did not increase conjunctivitis incidence in asthma, CRSwNP, or EoE trials, suggesting disease-specific ocular event profiles.
• Further research is warranted to understand the etiology and optimal treatment strategies for conjunctivitis in dupilumab-treated patients, especially those with AD.