Purpose: 

Dupilumab-induced ocular surface disease (DIOSD) is a common reaction among patients treated for atopic dermatitis. This study aimed to identify the clinical characteristics, associated risk factors, treatment strategies, and long-term outcomes of DIOSD.

Methods: 

We conducted a multicenter retrospective cohort study of consecutive adult outpatients treated with dupilumab for moderate-to-severe atopic dermatitis from 2017 through 2021 at 2 tertiary care centers. We used stepwise multivariable logistic regression to assess the association between patient characteristics and development of DIOSD.

Results: 

Among 210 patients treated with dupilumab, 37% (n = 78) developed DIOSD over the 52-week follow-up period. Vision-threatening complications including corneal scarring and cicatricial ectropion were noted in 1% (n = 3) of patients. Clinical features were blepharoconjunctivitis (68%, n = 53), burning/stinging/dryness (14%, n = 29), epiphora (13%, n = 10), pruritus (13%, n = 10), blurred vision (3%, n = 2), and photophobia (1%, n = 1). DIOSD was associated with a history of asthma (odds ratio: 2.94, 95% confidence interval: 1.26–6.87, P = 0.01) and a family history of atopic dermatitis (odds ratio: 2.58, 95% confidence interval: 1.08–6.17, P = 0.03). Interventions were initiated for 63% of patients with DIOSD, with artificial tears (56%) and corticosteroid drops (29%) most commonly used. Dupilumab was discontinued because of DIOSD in 4% of patients.

Conclusions: 

DIOSD is a common adverse event that is usually mild but may lead to treatment interruption and vision-threatening complications. A personal history of asthma and family history of atopic dermatitis may be associated with a higher risk of developing DIOSD.

中文翻译：

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成人特应性皮炎 Dupilumab 诱发的眼表疾病的患病率和特征

目的： 

Dupilumab 诱发的眼表疾病 (DIOSD) 是接受特应性皮炎治疗的患者中的常见反应。本研究旨在确定DIOSD 的临床特征、相关危险因素、治疗策略和长期结果。

方法： 

我们对 2017 年至 2021 年在 2 个三级护理中心连续接受 dupilumab 治疗中重度特应性皮炎的成人门诊患者进行了一项多中心回顾性队列研究。我们使用逐步多变量逻辑回归来评估患者特征与 DIOSD 发展之间的关联。

结果： 

在接受 dupilumab 治疗的 210 名患者中，37% (n = 78) 在 52 周的随访期内出现了 DIOSD。1% (n = 3) 的患者出现威胁视力的并发症，包括角膜疤痕和瘢痕性外翻。临床特征为眼睑结膜炎（68%，n = 53）、烧灼感/刺痛/干燥（14%，n = 29）、溢泪（13%，n = 10）、瘙痒（13%，n = 10）、视力模糊（ 3%，n = 2）和畏光（1%，n = 1）。DIOSD 与哮喘病史（比值比：2.94，95% 置信区间：1.26–6.87，P = 0.01）和特应性皮炎家族史相关（比值比：2.58，95% 置信区间：1.08–6.17，P = 0.03）。63% 的 DIOSD 患者开始接受干预，其中最常用的是人工泪液 (56%) 和皮质类固醇滴剂 (29%)。Dupilumab 因 4% 的患者出现 DIOSD 而停用。

结论： 

DIOSD 是一种常见的不良事件，通常很轻微，但可能导致治疗中断和危及视力的并发症。哮喘个人史和特应性皮炎家族史可能与患 DIOSD 的较高风险相关。