Dupilumab-associated ocular surface disease in atopic dermatitis: a large prospective cohort study from the BioDay registry.

PURPOSE: Dupilumab-associated ocular surface disease (DAOSD) is a frequently reported side effect in atopic dermatitis (AD) patients treated with dupilumab. This study aimed to investigate the frequency and severity of DAOSD, the effect of ophthalmic treatment on (DA)OSD, and the effect of dupilumab on conjunctival goblet cells (GCs).

DESIGN

Prospective, monocenter cohort study

PARTICIPANTS

Adult patients with moderate-to-severe AD from the BioDay registry treated with dupilumab at the University Medical Center Utrecht, the Netherlands.

METHODS

Ophthalmological and dermatological examinations were performed at baseline (start of dupilumab), week 4, and week 28, between February 2020 and January 2025. Ocular surface disease (OSD) severity was assessed using the Utrecht Ophthalmic Inflammatory and Allergic disease (UTOPIA) score. DAOSD was defined as a ≥3-point increase in UTOPIA score from baseline. Conjunctival impression cytology was performed to study the quantity and function of conjunctival GCs.

MAIN OUTCOME MEASURES: Frequency and severity of DAOSD, and the quantity and function of conjunctival GCs during dupilumab treatment.

RESULTS

OSD was present in 94.0% (n=141/150) of AD patients at baseline, while only 60.0% (n=90/150) reported ocular symptoms. During 28 weeks of dupilumab treatment, 30.7% (n=46/150) of patients developed DAOSD. The use of ophthalmic medication increased from 15.3% (n=23/150) at baseline to 64.7% (n=97/150) at week 28. GC numbers remained stable between baseline and week 28, while Mucin 5AC (MUC5AC) production in Cytokeratin 19-CD45-MUC5AC+ cells significantly decreased.

CONCLUSIONS

This study highlights the high prevalence of OSD in moderate-to-severe AD patients before dupilumab treatment. DAOSD was observed in 30.7% of patients, despite the increased use of ophthalmic treatment. While conjunctival GC numbers remain stable but low, dupilumab was associated with reduced MUC5AC expression.