Corticosteroids Help Treat Dupilumab-Associated Ocular Surface Disease

A study recently published in Cornea offers insight into the common signs and symptoms associated with dupilumab-associated ocular surface disease (DAOSD). The research highlights the efficacy of topical corticosteroids (TCS) and other immunomodulators in treating deleterious effects of dupilumab on the eye. Primarily, the drug can lead to conjunctivitis. The research also proposes a symptom-based grading system to guide nonophthalmic physicians in early disease recognition.

The retrospective chart review of patients with DAOSD was designed to describe common ocular signs and symptoms as well as describe and evaluate DAOSD treatment strategies. The research included 29 participants (mean age 46 ± 15.2 years, 17 women and 12 men, 79% Caucasian). The study included57 ophthalmic exams.

The authors offered a severity-rating system that ranks patients as either mild or severe. The system assigns 1 point to each of 5 criteria. The criteria include light sensitivity,  irritation or pain, discharge, redness, and pruritus. A total of 2 or lower is considered mild, a total of 3 or higher is severe. Using this model, 65.5% (n=19) of the study’s subjects were ranked severe and required topical immunomodulating therapy (including with corticosteroids) and 17.2% (n=5) ranked in the mild group.

The most commonly reported symptoms included pain/irritation (96.6%, n=28), redness (83%, n=24), pruritus (62%, n=18), and tearing (62%, n=18). The most frequent signs included conjunctival injection (62%, n=18), superficial punctate keratitis (55%, n=16), and papillary reaction (28%, n=8). Twenty-seven (93%) patients were diagnosed with conjunctivitis, 2 (7%) with keratitis, and 2 (7%) with blepharitis. 

The authors recommend mild cases be treated with mast cell stabilizers and follow up with a dermatologist. Patients who qualify as severe should receive an ophthalmology referral, according to the study. This cohort is commonly (79.3% n=23), treated with TCS. Of the 21 patients with follow-up documentation, 1 (4.8%) had no response, 16 (76.2%) demonstrated partial, and 4 (19.0%) demonstrated complete response to TCS.

Despite the limitations of the small cohort, which was lacking in ethnic diversity, and a setting that led to the inclusion of more participants with a severe grade of disease, the authors conclude that this study “provides insight into the commonly presenting ocular signs and symptoms associated with DAOSD and highlights the efficacy of TCS in improving symptoms associated with DAOSD. In addition, this study proposes a novel symptom-based grading system, which can guide dermatologists and other care providers toward an ophthalmology consult.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Bohner A, Topham C, Strunck J, et al. Dupilumab-associated ocular surface disease: clinical characteristics, treatment, and follow-up. Cornea. [published online, Aug 19, 2020]. doi: 10.1097/ICO.0000000000002461