TOPLINE

Among adults with moderate-to-severe atopic dermatitis (AD) treated with dupilumab, more than 90% had ocular surface disease (OSD) at baseline, and the same proportion still had it after at least 2 years of therapy. OSD worsened in 22.7% of patients in a pattern compatible with dupilumab-associated OSD, including some cases that appeared after the first 28 weeks.

METHODOLOGY

• Researchers conducted a prospective cohort study at a university hospital in Netherlands to determine the rate and severity of dupilumab-associated OSD in patients with moderate-to-severe AD after at least 2 years on treatment.
• They examined 44 patients (median age, 39.7 years; 54.5% men) who started treatment with dupilumab. Eye examinations took place at baseline, week 28, and after at least 2 years of treatment, with a median follow-up of 34.5 months.
• The severity of OSD was graded using the Utrecht Ophthalmic Inflammatory and Allergic disease (UTOPIA) score; higher scores indicated more severe disease. Dupilumab-associated OSD was defined as an increase of ≥ 3 points from baseline.
• The stability of the tear film was measured by tear breakup time, and tear production was measured with the Schirmer test. The number of conjunctival goblet cells and the amount of mucin 5AC they produced were assessed by impression cytology.

TAKEAWAY

• At baseline, 90.9% of patients already had OSD, and the same proportion had it at week 28 and at the last visit. Overall, 22.7% (10 of 44) developed worsening of OSD compatible with dupilumab-associated disease during follow-up, with a median time to onset of 14 weeks; in four patients, worsening developed after week 28.
• The mean scores on the UTOPIA scale showed nonsignificant reductions from baseline at week 28 and at the last follow-up.
• At the last follow-up, tear breakup time decreased significantly from baseline (mean difference, 1.59 seconds), whereas tear production increased significantly (mean difference, 7.44 mm; P < .001 for both).
• The median number of goblet cells decreased significantly from baseline to the last follow-up. Mucin 5AC production per goblet cell decreased significantly by week 28 and remained stable at the last follow-up.

IN PRACTICE

"These findings indicate that DAOSD [dupilumab-associated OSD] can persist or develop during long-term dupilumab treatment, highlighting the ongoing need for clinicians to monitor ocular side effects in AD patients," the authors wrote.

SOURCE

Nienke Veldhuis, with the University Medical Center Utrecht, Utrecht, Netherlands, was the corresponding author of the study, which was published online on September 29 in Clinical and Translational Allergy.

LIMITATIONS

The study included a relatively small number of patients and did not have a formal sample size calculation, which may have limited statistical power and the generalizability of the findings. Dupilumab-associated ocular disease was defined by a practical, nonvalidated 3-point increase in the score, which could not prove that dupilumab caused the worsening. Patients no longer on dupilumab by the last visit were excluded, which may have led to an underestimation of eye disease.

DISCLOSURES

The patients were drawn from the BioDay registry, which is sponsored by Sanofi/Regeneron, Eli Lilly and Company, Almirall, LEO Pharma, and Pfizer. Several authors reported receiving consulting fees and research support and serving as speakers or advisory board members for multiple pharmaceutical companies, including Sanofi, Regeneron Pharmaceuticals, AbbVie, Janssen, and Eli Lilly.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.