Dermatologic drug-associated ocular surface disease needs close attention
WAILEA, Hawaii — Dupilumab is an important treatment for patients with atopic dermatitis, but there can be ocular consequences, which themselves need treatment.
Approximately 10% of patients taking Dupixent (dupilumab, Sanofi/Regeneron) report eye issues, including conjunctivitis, keratitis, blepharitis, pruritus and dry eye, Francis S. Mah, MD, said in a panel discussion at Hawaiian Eye 2021.
Although ocular inflammation does appear to resolve when treatment is stopped, stopping treatment is a difficult choice for some patients because it works so well for their dermatologic problems.
“I have a number of patients with this storyline,” panelist Kenneth A. Beckman, MD, FACS, said. “It’s like a life-changing medication, and as bad as their eyes get, they will do whatever it takes to stay on the medication, and they will not stop it.”
Dupilumab-induced ocular surface disease can be cyclical, flaring at the time patients receive injections.
“They all are going to have ocular surface disease anyhow,” because of their dermatologic issues, Beckman said. “So, I’m usually putting them on one of the immunomodulators – cyclosporine or lifitegrast, I tend to lean that way first as a baseline before they ever have a problem, because I’m treating their dry eye.”
For flare-ups, Beckman adds a “loteprednol type” of medication.
“A lot of them are on a baseline of once a day and around the week of the injection, they need to go to two or three or four times a day,” Beckman said.
Because of the cyclical nature of the flares, Beckman monitors the patients closely.
“You need to be aggressive, and you need to get them early, because once it starts, it can be really difficult to get them out of the cycle,” he said. “It’s important to encourage the dermatologist in your community to get these patients in for almost like a plaquenil check,” he said.
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Mah FS, et al. Medical and surgical cornea: Panel case presentations. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.