Conjunctivitis in Adults with Atopic Dermatitis Treated with Dupilumab: An Observational Study of Clinical Characteristics, Symptomatology, and Treatment.

introductionConjunctivitis is more prevalent in patients with atopic dermatitis (AD) than the general population, and is the most common adverse event during dupilumab treatment for AD. We aimed to characterize conjunctivitis diagnosed during AD dupilumab treatment and to assess effectiveness of ophthalmic treatments.

methodsThis prospective observational study enrolled adults with AD who received the approved dupilumab regimen in a real-world setting for at least 8 weeks prior to enrollment. At baseline, we compared ophthalmic signs and symptoms in two cohorts of patients who had received dupilumab for similar duration: one with conjunctivitis (group 1) and one with no conjunctivitis (group 2). All patients continued treatment with dupilumab, and group 1 patients received treatment for conjunctivitis at the discretion of the investigator. We assessed effectiveness of prescribed treatments and the outcomes of conjunctivitis up to Week 60. All analyses were descriptive.

resultsA total of 35 patients were assessed in group 1 and 11 in group 2. Mean AD duration was 22.9 ± 15.2 years (group 1) and 13.1 ± 16.9 years (group 2). In group 1, 91% of patients reported a history of facial lesions during AD flares and 54% had current AD facial lesions, compared with 64% and 9%, respectively, in group 2. Ongoing facial contact dermatitis and rosacea were only reported in group 1 (11% and 9%, respectively). Common physical findings at baseline in group 1 compared with group 2 included periocular eczematous rash (65% vs. 18%) and/or lichenification (47% vs. 27%), posterior blepharitis with meibomian gland dysfunction (83% vs. 55%), bulbar hyperemia (89% vs. 46%) and conjunctival papillary pattern (69% vs. 27%); 24% of patients in group 1 and none in group 2 had corneal neovascularization, mostly in a single peripheral quadrant. There was no evidence of tear volume insufficiency. One patient in group 1 (3%) and two in group 2 (18%) had eyelash mites. Three patients (9%) in group 1 and one in group 2 (9%) had Staphylococcus aureus-positive conjunctival swabs. Most patients (88%) received multiple ophthalmic treatments for the qualifying conjunctivitis event. Investigators assessed topical corticosteroids and topical calcineurin inhibitors administered either as eye drops or ointment as the most effective treatments. Most conjunctivitis events recovered/resolved (84%) or were resolving/recovering (12%) at study end. Mean ± SD time to recovery from the initial visit was 171.9 ± 54.6 days. No participants discontinued treatment with dupilumab.

conclusionsProlonged history of AD and facial and/or eyelid AD lesions increased the likelihood of a conjunctivitis diagnosis during AD dupilumab treatment. Treatment of conjunctivitis with topical corticosteroids and/or calcineurin inhibitors resolved or controlled the event in most patients without need to discontinue dupilumab. CLINICAL TRIAL: GOV: ClinicalTrial.gov Identifier: NCT04287608.