Ocular Surface Disease in Patients With Atopic Dermatitis Treated With Dupilumab: A Prospective Case-Control Study

Area of Science:

• Ophthalmology
• Dermatology
• Pharmacology

Background:

• Atopic dermatitis (AD) is a chronic inflammatory skin condition.
• Dupilumab is a biologic therapy targeting IL-4 and IL-13, used for moderate-to-severe AD.
• Ocular surface complications, including dry eye disease (DED), can occur in patients with AD.

Purpose of the Study:

• To investigate the prevalence and characteristics of DED in patients with moderate-to-severe AD undergoing treatment with dupilumab.
• To assess changes in DED parameters and ocular side effects over a six-month period.

Main Methods:

• A prospective case-control study involving patients with AD treated with dupilumab and a healthy control group.
• Data collected included DED prevalence, Ocular Surface Disease Index (OSDI), tear film breakup time (TBUT), osmolarity, Oxford staining, and Schirmer test results at baseline, 1 month, and 6 months.
• Eczema Area and Severity Index (EASI) and ocular side effects were also recorded.

Main Results:

• DED prevalence increased significantly from 16.7% to 33.3% in the dupilumab group after six months (P=0.001), while remaining stable in controls.
• Patients on dupilumab showed increased OSDI and Oxford scores, and decreased TBUT and Schirmer test results at six months.
• Common ocular side effects included conjunctivitis (42%) and blepharitis (36%); no severe events or treatment discontinuations occurred.

Conclusions:

• Dupilumab treatment for atopic dermatitis is associated with an increased prevalence and worsening of dry eye disease symptoms over six months.
• Despite the increased DED, dupilumab therapy was generally well-tolerated with no severe ocular adverse events reported.
• Further research is needed to understand the mechanisms behind dupilumab-induced DED and to develop management strategies.