Evaluation of Risk Factors for Dupilumab-Associated Ocular Sequelae in the Treatment of Atopic Dermatitis

Dupilumab is a monoclonal antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13) signaling and is used in the treatment of moderate-to-severe atopic dermatitis (AD) in those six months or older who are uncontrolled on or cannot tolerate topical treatments. Ocular surface disease is a recognized adverse effect of dupilumab, yet few studies describe the risk factors for developing ocular adverse effects. There are no standardized recommendations for monitoring patients on this medication. This study aims to highlight the risk factors associated with the development of dupilumab-associated ocular surface disease (DAOSD) described in the literature. The PubMed and ScienceDirect databases were searched in April 2024 using key search terms. Nine articles were included after deduplication, title/abstract screening, full-text review, and quality appraisal. Studies were included if they were written in English and discussed risk factors for the ocular side effects of dupilumab. Studies were excluded if they discussed other biological agents or ocular conditions of other origins. Out of the nine studies analyzed, six described prior history of ocular disease as a risk factor for developing DAOSD. Severe AD was highlighted as a risk factor in five out of nine studies. Elevated total immunoglobulin E (IgE) levels and eosinophil count were described as risk factors in four out of nine studies. Three studies cited facial or eyelid eczema, and two studies highlighted family history of atopy as having an association with the development of DAOSD. One study described high levels of chemokines, as well as the personal history of other atopic conditions, as independent risk factors. While the etiology of DAOSD is not fully understood, past studies have elucidated potential risk factors for its development. Those being treated with dupilumab for AD have higher severity or refractory disease, and the discontinuation of treatment due to ocular side effects may have implications on the quality of life for these patients. Additional studies are needed to better understand the risk factors for DAOSD and prevent further complications.