Systematic Review
Dupilumab ocular side effects in patients with atopic dermatitis: a systematic review
N. Neagu,
C. Dianzani,
G. Avallone,
C. Dell’Aquila,
S.-H. Morariu,
I. Zalaudek,
C. Conforti,
Corresponding Author
N. Neagu
State Clinic of Dermatology, Mureş County Hospital, Tîrgu Mureş, Romania
These authors have equally contributed.Correspondence: N. Neagu. E-mail: [email protected]
Search for more papers by this authorC. Dianzani
Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
These authors have equally contributed.Search for more papers by this authorG. Avallone
Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
Search for more papers by this authorC. Dell’Aquila
Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
Search for more papers by this authorS.-H. Morariu
State Clinic of Dermatology, Mureş County Hospital, Tîrgu Mureş, Romania
Search for more papers by this authorI. Zalaudek
Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
Search for more papers by this authorC. Conforti
Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
Search for more papers by this authorN. Neagu,
C. Dianzani,
G. Avallone,
C. Dell’Aquila,
S.-H. Morariu,
I. Zalaudek,
C. Conforti,
Corresponding Author
N. Neagu
State Clinic of Dermatology, Mureş County Hospital, Tîrgu Mureş, Romania
These authors have equally contributed.Correspondence: N. Neagu. E-mail: [email protected]
Search for more papers by this authorC. Dianzani
Plastic and Reconstructive Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
These authors have equally contributed.Search for more papers by this authorG. Avallone
Medical Sciences Department, Section of Dermatology, University of Turin, Turin, Italy
Search for more papers by this authorC. Dell’Aquila
Department of Medical, Surgical Sciences and Health, Eye Clinic, University of Trieste, Trieste, Italy
Search for more papers by this authorS.-H. Morariu
State Clinic of Dermatology, Mureş County Hospital, Tîrgu Mureş, Romania
Search for more papers by this authorI. Zalaudek
Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
Search for more papers by this authorC. Conforti
Dermatology Clinic, Maggiore Hospital of Trieste, Trieste, Italy
Search for more papers by this authorConflict of interest
The authors declare no conflict of interest.
Funding sources
The authors received no financial support for the research, authorship, and/or publication of this article.
Abstract
Atopic dermatitis (AD) is a chronic, inflammatory skin disorder that most frequently occurs in children, but it can also affect adults. Even though most AD cases can be managed with topical treatments, moderate-to-severe forms require systemic therapies. Dupilumab is the first human monoclonal antibody approved for the treatment of AD. Its action is through IL-4 receptor alpha subunit inhibition, thus blocking IL-4 and IL-13 signaling pathways. It has been shown to be an effective, well-tolerated therapy for AD, as well as for asthma, chronic rhinosinusitis with nasal polyposis (CRSwNP), and eosinophilic esophagitis (EoE). However, an increasing incidence of dupilumab-induced ocular surface disease (DIOSD) has been reported in patients treated with dupilumab, as compared to placebo. The aim of this study was to summarize scientific data regarding DIOSD in AD patients treated with dupilumab. A search of PubMed and clinicaltrials.gov databases was performed. There was no limit to study design. All AD cases were moderate-to-severe. DIOSD was either dermatologist-, allergist-, or ophthalmologist-assessed. Evidence shows that DIOSD occurs most frequently in patients with atopic dermatitis and not in other skin conditions, neither in patients with asthma, CRSwNP, nor EoE who are on dupilumab treatment. Further studies are warranted in order to establish a causal relationship between dupilumab and ocular surface disease. Nevertheless, ophthalmological evaluations prior to dupilumab initiation can benefit AD patients with previous ocular pathology or current ocular symptomatology. Also, patch testing for ocular allergic contact dermatitis might be advantageous in patients with a history of allergic conjunctivitis. Furthermore, TARC, IgE, and circulating eosinophils levels might be important biomarkers for a baseline assessment of future candidates to dupilumab treatment. However, TARC measurements should be resumed for research purposes only.
Open Research
Data availability statement
The data we included in this manuscript are openly available in a public repository that issues datasets with DOIs.
Supporting Information
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Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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