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Case Reports
. 2022 Apr 9:26:101528.
doi: 10.1016/j.ajoc.2022.101528. eCollection 2022 Jun.

Dupilumab-associated cicatrizing ocular disease

Amit K Reddy  1 , Scott G Hauswirth  1 , Darren G Gregory  1 , Sophie D Liao  1 , Alan G Palestine  1
Affiliations
Case Reports

Dupilumab-associated cicatrizing ocular disease

Amit K Reddy et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To describe three cases of bilateral cicatrizing conjunctivitis associated with dupilumab treatment for atopic dermatitis.

Observations: Case 1 is a 69 year-old male with a history of mild, stable cicatrizing conjunctivitis thought to be secondary to atopic dermatitis. His cicatrizing disease progressed significantly after starting dupilumab, and then stabilized after dupilumab was discontinued. Case 2 is a 72 year-old male who presented with bilateral cicatrizing conjunctivitis. His symptoms of ocular erythema and irritation started shortly after initiating dupilumab for atopic dermatitis. The dupilumab was discontinued and the patient's symptoms resolved and ocular surface scarring stabilized. Case 3 is a 47 year-old male with a history of allergic conjunctivitis who was found to have new onset unilateral symblepharon approximately 12 months after starting dupilumab for atopic dermatitis. The dupilumab was discontinued and his ocular disease stabilized. However, his cutaneous symptoms worsened significantly, so dupilumab was restarted at half the previous dose. His atopic dermatitis symptoms improved and cicatrizing conjunctivitis remained stable on this regimen.

Conclusions and importance: Cicatrizing conjunctivitis with symblepharon formation distinct from ocular cicactricial pemphigoid is a potential side effect of dupilumab therapy for atopic dermatitis. Progression of the cicatrization appears to halt with discontinuation, or potentially dose reduction, of dupilumab.

Keywords: Atopic dermatitis; Cicatrizing conjunctivitis; Dupilumab; Pseudopemphigoid.

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Conflict of interest statement

No financial disclosure or conflicting relationship exists for any author.

Figures

Fig. 1
Fig. 1
A. Case 1. Left eye with conjunctival injection, inferior forniceal shortening, and new symblepharon after starting dupilumab for atopic dermatitis. Fig. 1B. Case 2. Left eye with inferior forniceal shortening, symblepharon, and sub-conjunctival fibrosis after starting dupilumab for atopic dermatitis. Fig. 1C. Case 3. Right eye with new inferior forniceal shortening, symblepharon, and sub-conjunctival fibrosis after starting dupilumab for atopic dermatitis.
See this image and copyright information in PMC

References

    1. Simpson E.L., Bieber T., Guttman-Yassky E., et al. Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. N Engl J Med. Dec 15 2016;375(24):2335–2348. doi: 10.1056/NEJMoa1610020. - DOI - PubMed
    1. Popiela MZ, Barbara R, Turnbull AMJ, et al. Dupilumab-associated ocular surface disease: presentation, management and long-term sequelae. Eye (Lond). Jan 28 2021;doi:10.1038/s41433-020-01379-9. - PMC - PubMed
    1. Barnes A.C., Blandford A.D., Perry J.D. Cicatricial ectropion in a patient treated with dupilumab. Am J Ophthalmol Case Rep. 2017;7:120–122. doi: 10.1016/j.ajoc.2017.06.017. - DOI - PMC - PubMed
    1. Levine R.M., Tattersall I.W., Gaudio P.A., King B.A. Cicatrizing blepharoconjunctivitis occurring during dupilumab treatment and a proposed algorithm for its management. JAMA Dermatol. Dec 1 2018;154(12):1485–1486. doi: 10.1001/jamadermatol.2018.3427. - DOI - PubMed
    1. Blauvelt A., de Bruin-Weller M., Gooderham M., et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet. Jun 10 2017;389(10086):2287–2303. doi: 10.1016/S0140-6736(17)31191-1. - DOI - PubMed

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