P34: Reduction in the incidence of dupilumab-induced ocular surface disease by a preventative topical eye treatment regime

P. Babakinejad,¹ D.S. Bajwa,¹ N.J. Reynolds,¹ S. Ball,¹ S. Pradhan,² F.C. Figueiredo² and S. Meggitt¹

¹Department of Dermatology, Royal Victoria Infirmary and ²Department of Ophthalmology, Royal Victoria Infirmary, Newcastle upon Tyne, UK

Dupilumab-induced ocular surface disease (DIOSD) is a recognized and common adverse effect of dupilumab. However, the management or prophylactic treatment of DIOSD is not currently standardized. The aim of this quality-improvement project was to evaluate the proportion of patients with DIOSD in a tertiary atopic dermatitis clinic, and to assess whether a new topical eye treatment regime will have an impact in reducing the incidence of DIOSD. A total of 67 patients {29 women and 38 men with a median age of 40 years [range 18–74] and a median Eczema Area and Severity Index [EASI] score of 21 [interquartile range (IQR) 14·6–32·1]} who had commenced dupilumab between September 2018 and May 2019 were included in the initial review of data. Data were collected from the patients’ electronic records. DIOSD was recorded in 17 (25%) patients. The high incidence of DIOSD is in keeping with the high rates of conjunctivitis (8·6–22·1%) demonstrated in clinical trials of dupilumab (Akinlade B, Guttman-Yassky E, de Bruin-Weller et al. Conjunctivitis in dupilumab clinical trials. Br J Dermatol 2019; 181: 459–73). Prophylactic topical treatment for DIOSD, during the initiation of dupilumab therapy, including ketotifen drops (preservative-free) twice daily to both eyes, hydrocortisone 0·5% ointment twice daily to the eyelids of both eyes and a lubricating eye gel as required to both eyes was recommended by ophthalmology. A second group of 31 patients [15 women and 16 men with a median age of 41 years (range 18–78) and a median EASI score of 21 (IQR 16·3–24)] who had commenced dupilumab between January 2020 and November 2020 were included in the prophylactically treated group. The reported incidence of DIOSD in this group was 13% (n = 4). The incidence of DIOSD was lower in the prophylactically treated group than in the control cohort. The baseline severity of eczema was largely similar between the two groups, suggesting that the most important factor in the reduction in incidence of DIOSD was the introduction of the prophylactic topical eye treatment. Further prospective recruitment with longer follow-up specifically focusing on the efficacy of prophylactic topical treatment in patients prior to starting dupilumab is under way.