Dupilumab-related ocular surface disorders in a paediatric cohort with atopic dermatitis, treated in a tertiary paediatric hospital in London

Background

Dupilumab is the first human monoclonal antibody approved for the treatment of moderate–severe atopic dermatitis (AD) in children from 6 years of age. Real-world studies reviewing dupilumab-related ocular surface disorders (DROSD) in the paediatric population are needed to detail ophthalmological findings.

Objectives

This cross-sectional observational study aimed to review the incidence, features, and ophthalmological findings of DROSD in a real-world paediatric cohort, treated with dupilumab for AD.

Methods

Pharmacy and electronic medical records were used to identify all patients prescribed dupilumab for AD from April 2019 to July 2022. Data, including demographics, ocular signs and symptoms, severity and treatments, were collected and analysed.

Results

We identified 46 patients, with a median age of treatment initiation of 12 years (range 9–14 years). Twelve patients (26.1%) developed DROSD. Mean time to development of DROSD was 4.1 months (±2.4 months, 95% confidence interval). Two patients (16.7%) with DROSD had severe eye findings including peripheral corneal opacification, one of which had reported only asymptomatic red eyes. Ocular signs included 91.7% (11/12) bulbar conjunctival injection, 41.7% (5/12) follicle involvement (limbal or forniceal), 25% (3/12) diffuse tarsal-conjunctival thickening, 16.7% (2/12) featureless thickening, 16.7% (2/12) peripheral corneal opacification, 8.3% (1/12) cicatrisation and 8.3% (1/12) periorbital skin changes. No patients ceased treatment due to DROSD.

Conclusions

This study had a higher incidence of DROSD, compared to other real-world paediatric studies but had a similar incidence to real-world adult studies. Patient-reported eye symptoms did not always correlate to severity of DROSD. Larger paediatric studies looking at the incidence and long-term outcome of DROSD are needed.