Ron Jans Award Winner: Characterising dupilumab-induced ocular surface disease in adult patients with moderate-severe atopic dermatitis: a multicenter cohort study
Authors: Tina Felfeli, Jorge R. Georgakopoulos, Christine E. Jo, Aaron M. Drucker, Michael Mimouni, Vincent Piguet, Jensen Yeung, Clara Chan.
Disclosure Block: T. Felfeli: None. J.R.
Georgakopoulos: None. C.E. Jo: None. A.M. Drucker:
None. M. Mimouni: None. V. Piguet: None. J.
Yeung: None. C. Chan: None.
Abstract Title: Characterising dupilumab-induced ocular surface disease in adult patients with moderate-to-severe atopic dermatitis: A multicenter cohort study
Purpose: Dupilumab is a monoclonal antibody that blocks interleukin (IL)-4 and IL-13, and the only non-topical therapy with Health Canada approval for moderate-to-severe atopic dermatitis (AD), which affects up to 9% of individuals in Canada. Dupilumab-induced ocular surface disease (DIOSD) represents one of the most common adverse events (AE) of this treatment, with important implications for quality of life and treatment interruptions. This study aims to report the incidence, characteristics, and long-term outcomes of DIOSD.
Study Design: A multicenter longitudinal cohort study.
Methods: All adult patients (≥18 years) with moderate-to-severe AD (Investigator Global Assessment [IGA] of 3 or 4 at baseline) treated with dupilumab 300 mg since Health Canada approval in 2017 at three tertiary care academic centres were identified. Patients were followed for the duration of treatment to determine 16-week and 52-week safety and efficacy outcomes.
Results: Of the 210 patients on dupilumab during the study period, 37% developed DIOSD at any point throughout the treatment period (29% at 16-week and 24% at 52-week follow-ups). Most commonly documented DIOSD features included marked blepharoconjunctivitis (50/78, 64%), burning/stinging (29, 37%), and epiphora (10, 13%). Three patients developed corneal scaring and one developed cicatricial ectropion. Baseline blood eosinophil levels were correlated with severity of ocular symptoms during the 52-week follow-up period (r=0.22, p=0.011). Of those who received treatment for DIOSD, therapeutic interventions included artificial tears (26/49, 53%), corticosteroid drops (15, 31%), antihistamine drops (7, 14%), topical tacrolimus or pimecrolimus (4, 8%) and cyclosporine drops (1, 2%). Due to the severity of ocular manifestations, ongoing follow-up with ophthalmology was required for 18% (14/78) of patients. Of all patients with reported DIOSD at any point throughout the study period, 48% (37/77) had ongoing symptoms beyond the 52-week follow-up timepoint. Dupilumab discontinuation secondary to DIOSD was noted in 4% (9/210) of patients over the follow-up period.
Conclusions: This is the largest cohort study with longitudinal follow-up for DIOSD in adult patients with moderate-to-severe AD. The high proportion of patients with persistent ocular symptoms beyond 52 weeks and incidence of dupilumab cessation highlights the need for improved ophthalmic care for this potentially vision threatening AE. Screening for DIOSD is strongly recommended to implement early ophthalmic interventions for vision threatening complications and reduce the number of patients who discontinue dupilumab. Blood eosinophil count may be used as a baseline predictor of DIOSD severity and guide ophthalmic interventions.