687 - Treatment of conjunctivitis in dupilumab-treated patients with atopic dermatitis: an observational study
Authors: Asbell Penny , Akpek Esen K , Chamberlain Winston , Chen Zhen , Coleman Anna , Rossi Ana B , Shumel Brad 
Published: August 2024

Abstract

Introduction/Background
Patients with atopic dermatitis (AD) have greater risk of conjunctivitis and other ocular surface disorders than the general population. In clinical trials of dupilumab in adult patients with moderate-to-severe AD, conjunctivitis and other ocular surface adverse events (AEs) were reported more frequently in patients who received dupilumab than in those who received placebo. Clinical features of ocular AEs in dupilumab-treated patients with AD are not well characterized, and there is a need for consensus on management approaches.

Objectives
To assess treatment and outcomes for conjunctivitis associated with dupilumab treatment for AD.

Methods
Treatment patterns and outcomes were assessed during a prospective observational study evaluating conjunctivitis in dupilumab-treated patients with AD (group 1) and a dupilumab-treated reference group of patients with AD without ocular symptoms (group 2). Patients were initially prescribed dupilumab by a dermatologist for treatment of AD. After at least 8 weeks, a patient was eligible to be referred to an ophthalmologist, who then determined final eligibility for the study. Dupilumab-treated patients with AD and conjunctivitis that had newly developed or significantly worsened (group 1) were followed for at least 24 weeks. A reference group of dupilumab-treated patients with AD without ocular symptoms (group 2) was evaluated at baseline visit with the ophthalmologist and Week 4. All ophthalmological treatments were at the discretion of the ophthalmologist, who also assessed conjunctivitis treatment effectiveness.

Results
A total of 49 patients were enrolled: 35 patients in Group 1 and 14 patients in Group 2. 3 patients in Group 2 who presented with active ocular inflammation at the initial visit were excluded from further analysis. 16 Group 1 patients (46%) and 7 Group 2 patients (64%) had a history of an ocular disorder prior to enrollment. Group 1 patients were diagnosed with AD at a younger age compared with group 2, with longer AD duration. More patients in group 1 reported history of facial AD lesions, including eyelid involvement, and history of AD facial lesions during flares. The most frequent ophthalmological diagnoses in Group 1 were non-infective conjunctivitis (46%), allergic conjunctivitis (26%) and keratoconjunctivitis (14%). The most prominent symptom was itching, followed by redness, grittiness/sandiness, swelling, tearing, burning, stinging, and light sensitivity. Corticosteroid (eye drops) were the most frequently prescribed treatment (n = 46) and their effectiveness was assessed by the ophthalmologist as excellent in 39.1% of uses and very good in 39.1%. Topical calcineurin inhibitors (either tacrolimus ointment or cyclosporin eye drops) were the next most frequently prescribed treatment (n = 31) and their effectiveness assessed as excellent in 45.2% of uses and very good in 12.9%. In participants who completed at least 24 weeks of observation, most events recovered/resolved (21/25 [84.0%]) or were resolving/recovering (3/25 [12.0%]); 1/25 [4.0%] participant had an event that was not recovered/resolved. No participants discontinued treatment with dupilumab.

Conclusions
Patients with AD treated with dupilumab with prolonged history of AD and facial and/or eyelid lesions may be more prone to developing ocular events. Both topical corticosteroids (eyedrops) and topical calcineurin inhibitors (eyedrops or ointment) resulted in resolution of ocular signs and symptoms and recovery in most patients, without dupilumab discontinuation.