Distinct ocular safety profiles of dupilumab and upadacitinib in atopic dermatitis: a real-world study with ophthalmological and microbiological assessment.

Abstract

Background: Dupilumab is highly effective in atopic dermatitis (AD) but is associated with ocular surface disease, whereas Janus kinase (JAK) inhibitors may have a more favorable ocular safety profile.

Objectives: To compare ocular outcomes and conjunctival microbiology in patients with moderate-to-severe AD treated with dupilumab versus upadacitinib.

Methods: In this prospective real-world study, adult patients were treated with dupilumab or upadacitinib and evaluated at baseline and after 16 weeks. Ocular assessment included the Ocular Surface Disease Index (OSDI) and Schirmer test. Conjunctival swabs were collected for culture. Dermatological outcomes were assessed using EASI and DLQI.

Results: Ninety-six patients were included (upadacitinib, n = 52; dupilumab, n = 44). Both treatments significantly improved EASI and DLQI. Conjunctivitis occurred in 39.0% of dupilumab-treated patients and in none of the upadacitinib-treated patients (p < .001). OSDI improved with upadacitinib (-8.3) but worsened with dupilumab (+2.1) (p < .001). Schirmer test results and bacterial colonization did not differ between groups.

Conclusions: Dupilumab and upadacitinib showed comparable dermatological efficacy but distinct ocular safety profiles. Dupilumab was associated with more frequent conjunctivitis and worsening ocular symptoms.