Dupilumab-Associated Mucin Deficiency (DAMD)

Area of Science:

• Ophthalmology
• Immunology
• Biochemistry

Background:

• Dupilumab, a monoclonal antibody targeting IL-4Rα, effectively treats atopic diseases.
• Conjunctivitis is a known side effect of dupilumab, but its mechanism remains unclear.
• Interleukin-13 (IL-13) plays a role in ocular surface immunity and mucin production.

Purpose of the Study:

• To investigate if dupilumab-induced IL-13 blockade leads to a relative deficiency of ocular mucin.
• To assess Mucin 5AC (Muc5AC) levels in patients using dupilumab compared to controls.

Main Methods:

• Tear samples were collected from 14 patients (7 on dupilumab, 7 controls) for Muc5AC and total protein analysis.
• Ocular surface findings were documented photographically.
• Patients completed questionnaires on ocular surface symptoms.

Main Results:

• Patients on dupilumab showed significantly lower normalized Muc5AC levels (1.54 ng/mg) compared to controls (7.99 ng/mg).
• Dupilumab users reported increased ocular fatigue, discomfort, pain, redness, and itching.
• This is the first study to demonstrate a relative Muc5AC deficiency in dupilumab users.

Conclusions:

• Dupilumab use is associated with a relative deficiency of ocular Mucin 5AC.
• This deficiency may contribute to the conjunctivitis observed in patients treated with dupilumab.
• Further research is needed to understand the clinical significance of Muc5AC deficiency in dupilumab-associated conjunctivitis.