Dupilumab-Associated Ocular Surface Disease in Patients with Atopic Dermatitis Is Frequent: A Nationwide Real-World Evidence Study

INTRODUCTION: New biologic treatments are increasingly used for the treatment of moderate-to-severe atopic dermatitis (AD). This study examined clinical characteristics of patients with Dupilumab-associated ocular surface disease (DAOSD). METHODS: A total of 382 patients were included in a retrospective nationwide cohort study of all Danish adults treated with Dupilumab for AD for more than 16 weeks. RESULTS: The frequency of DAOSD was 37.7% with a median follow-up of 1.6 years. Before initiating treatment, 61.3% of the DAOSD patients already had preexisting ocular surface disease (OSD), why the DAOSD group was then subdivided in two groups: one with preexisting OSD and one without preexisting OSD. Patients who developed DAOSD had a longer median duration of AD (41.5 and 44 for patients with preexisting OSD and patients without preexisting OSD) vs. 33 years (non-DAOSD), p = 0.005, a higher median reduction in EASI score (93.3% and 90.2% vs. 83.8%, p = 0.006) and more frequently rhinitis (49.4% and 52.7% vs. 37.1%, p = 0.031). In 75% of cases, DAOSD presented before week nine, conjunctivitis was the most common sign of DAOSD (73.2%) and to treat DAOSD, ophthalmologists prescribed lubricating eye drops to patients with preexisting OSD and patients without preexisting OSD drops in 88.5% and 87.3 of the cases, and mild (e.g., hydrocortisone) and strong (e.g., dexamethasone) corticosteroid eye drops equally frequent (24.1 and 25.3% vs. 16.4% and 29.1%). In 5% of the cohort, Dupilumab treatment was discontinued due to DAOSD (n = 19), even though these patients received lubricating eye drops (84%), mild steroids (41.1), and strong steroids (31.6%). CONCLUSION: DAOSD should be recognized by dermatologists and should lead to consideration of early referral to ophthalmologists.