Dupilumab-Linked Ocular Surface Disease Affects Nearly One-Third of Atopic Dermatitis Patients but Rarely Forces Discontinuation

Ocular surface disease (搜索)搜索该疾病 (OSD) emerged in 30.7% of patients with moderate-to-severe atopic dermatitis (搜索)搜索该疾病 (AD) during 28 weeks of treatment with Dupixent查看药品详情 (dupilumab查看药品详情), yet the complication rarely led to treatment discontinuation, according to a Dutch study published in the American Journal of Ophthalmology. The findings, drawn from the BioDay registry, underscore a persistent gap between the clinical burden of dupilumab-associated OSD and its recognition in routine practice.

The prospective analysis enrolled 150 patients with moderate-to-severe AD who underwent dermatological and ocular examinations at baseline and at weeks four and 28 of dupilumab查看药品详情 treatment. Investigators graded OSD severity using the Utrecht Ophthalmic Inflammatory and Allergic Disease grading scale. Reported ocular surface symptoms included blepharitis, meibomian gland dysfunction, conjunctivitis and tear instability.

Baseline Ocular Disease Far Outpaces Reported Symptoms

OSD was already present in 94% of AD patients at baseline, although only 60% reported symptoms — a discrepancy the authors interpret as evidence that OSD is frequently underrecognized in this patient population. The high baseline prevalence points to a pre-existing ocular vulnerability in patients with moderate-to-severe AD rather than a phenomenon arising solely from therapy.

During the 28-week treatment period, 30.7% of patients developed dupilumab查看药品详情-associated OSD, with a median onset of 10 weeks. Between week four and week 28, 18.7% of patients had persisting or new-onset findings.

Ophthalmic Intervention May Explain Low Discontinuation

Ophthalmic treatment, including anti-inflammatory eye drops or ointment, was frequently initiated during the study. The authors suggest this proactive management may have contributed to the low number of patients requiring changes to dupilumab查看药品详情 therapy because of ocular side effects. Dupilumab dosing was tapered in three patients, and discontinuation was necessary in only one.

"This low discontinuation rate aligns with long-term data from a large cohort within our BioDay registry, which reported a discontinuation rate of only 3% over five years of dupilumab查看药品详情 treatment," the authors wrote. "Overall, these findings suggest that although dupilumab-associated OSD is common, it rarely leads to discontinuation of dupilumab in daily practice, possibly because ophthalmic treatment is frequently initiated."

Goblet Cells Stable, MUC5AC Expression Reduced

Patients with moderate-to-severe AD had significantly low conjunctival goblet cell numbers at baseline, indicating a pre-existing susceptibility to OSD. While goblet cell counts remained low and stable throughout the study, dupilumab查看药品详情 treatment was associated with a significant decrease in MUC5AC (搜索)搜索该靶点 expression — a mucin protein relevant to tear film stability.

"Overall, our results suggest that dupilumab查看药品详情 treatment was associated with reduced MUC5AC (搜索)搜索该靶点 expression, although larger studies are needed to confirm these findings," the authors wrote.

Implications for Cross-Specialty Management

The study concludes that although OSD is a frequently observed side effect of dupilumab查看药品详情 therapy, it rarely necessitates discontinuation, likely because ophthalmic interventions are commonly initiated. The authors emphasize the importance of close collaboration between dermatologists and ophthalmologists to manage OSD effectively in patients with atopic dermatitis (搜索)搜索该疾病 receiving dupilumab.