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How to manage conjunctivitis in AD patients treated with a biologic

Presented by
Prof. Tilo Biedermann, Helmholtz Center Munich, Germany
EADV 2019
The IL-4/IL-13 blocker dupilumab is the first approved biologic for therapy with atopic dermatitis (AD). It is remarkably effective, but a relatively frequent side effect is conjunctivitis, which is best managed preventively [1].

Dupilumab is a highly effective therapy for patients with moderate-to-severe AD. When applied together with topical corticosteroids, 39% of patients gained complete or almost complete healing of skin lesions (corresponding to IGS 0/1) with this drug, which could be maintained over a year [2]. “This is a huge step forward for the management of patients with moderate-to-severe disease,” said Prof. Tilo Biedermann (Helmholtz Center Munich, Germany). In real life, he has seen a very similar effect: patients respond quickly and about half of patients gain an EASI 90 response after 8 weeks.

“A small drawback of this effect is conjunctivitis, which we see in 8 to 10% of our patients,” said Prof. Biedermann. Pathogenesis, clinical characteristics, and treatment options for this conjunctivitis are still not characterised well. Typical symptoms are redness in both eyes and tearing. Further symptoms such as itch, stinging, burning, and foreign body sensation are seen in most but not in all patients [3].

Prof. Biedermann pointed out that this side effect could best be managed by preventive treatment with an emollient for the eyelids. Another possibility is the use of topical pimecrolimus cream. In addition, artificial tears should be used both in advance and after conjunctivitis has occurred. “In most cases, we encounter mild forms of conjunctivitis that can be managed with eye drops containing hyaluronic acid or without treatment,” said Prof. Biedermann. In his experience, antihistamines are not effective in dupilumab-related conjunctivitis. The incidence of conjunctivitis was associated with both AD severity and prior history of conjunctivitis [4].

In severe cases, eye drops containing fluorometholon (0.1%) or ciclosporine (1mg/ml eye drops) proved to be effective [3].

    1. Biedermann T. D1T01.1B, EADV 2019, 9-13 Oct, Madrid, Spain.
    2. Blauvelt A, et al. Lancet 2017;389:2287-303.
    3. Wollenberg A, et al. J Allergy Clin Immunol 2018;6:1778-80.
    4. Akinlade B, et al. Br J Dermatol 2019;181:459-73.

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