Roselie Achten

In a recent study from the Netherlands, atopic dermatitis (AD) patients with moderate-to-severe ocular surface disease (OSD) were found to have higher dupilumab tear fluid levels than those with moderate or no OSD.

These findings suggest that dupilumab both reaches the ocular surface and directly binds CD45-conjunctival epithelial cells, perhaps contributing to OSD development.

The major goal of the investigators’ research was to assess the levels of dupilumab in tear fluid and serum, and then connect this information to the severity of OSD during dupilumab treatment with AD patients.

The research was led by Roselie Achten, who works at the National Expertise Center for Atopic Dermatitis’s Department of Dermatology and Allergology at University Medical Center Utrecht in the Netherlands.

“Patients with moderate-to-severe OSD had higher dupilumab tear fluid levels compared to patients with no or mild OSD, indicating that dupilumab reaches the ocular surface,” Achten and colleagues wrote. “Dupilumab was also detected in conjunctival cell suspensions and was found to directly bind CD45-conjunctival epithelial cells.”

Research

The study was a single-center, prospective, observational cohort study with adult AD patients included as participants between February of 2020 and September of 2021.

The participants included were from the University Medical Center Utrecht (UMCU) in the Netherlands and the researchers only used those who were not using systemic immunosuppressive therapies for 2 weeks minimum prior to dupilumab.

The investigators had the AD patients receive examinations by dermatologists and ophthalmologists prior to baseline, then following 4 weeks, then following 28 weeks of dupilumab.

When the study participants were at baseline, they were given a full ophthalmological exam and then given a 600 mg dose of dupilumab. This was later followed by 300 mg injections every other week.

The research team reported on patient characteristics and AD severity, based on participants’ Eczema Area and Severity Index (EASI)scores and their Investigator's Global Assessment (IGA) scores.

They also assessed the existence or absence of other atopic comorbidities in the study participants.

Findings

The investigators’ findings indicated that dupilumab was higher in tear fluid for these AD patients, noting that it reaches the ocular surface and directly binds CD45-conjunctival epithelial cells.

The investigators posited that this may indicate that OSD development is affected by dupilumab use in AD patients.

The research team noted that 89.6% (n = 43/48) of the study participants reported OSD, and that 50% reported having moderate-to-severe OSD.

The median tear fluid levels noted by the investigators following Week 28 of dupilumab were 0.55 mg/L (IQR 0.35 – 1.31) and 0.29 mg/L (IQR 0.16 – 0.60) in patients with moderate-to-severe OSD and those with no or mild OSD, respectively (P = 0.02).

Median dupilumab tear fluid amounts were 0.55 following 28 weeks of treatment with the drug, and the researchers could detect dupilumab levels on conjunctival epithelial cells of 5 patients with AD after 4 weeks.

“In conclusion, dupilumab-treated AD patients with moderate-to-severe OSD had higher dupilumab tear fluid levels compared to patients with no or mild OSD,” they wrote. “This might be explained by a disrupted blood-tear barrier.”

The study, titled “High dupilumab levels in tear fluid of atopic dermatitis patients with moderate-to-severe ocular surface disease,” was published online in Clinical & Translational Allergy.