Dupilumab-associated ocular surface disease: An interdisciplinary decision framework for prescribers in the Australian setting.

Autor: Foley P; Department of Dermatology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.; Department of Medicine, The University Melbourne, Melbourne, Victoria, Australia.; Skin Health Institute, Melbourne, Victoria, Australia., Kerdraon YA; Save Sight Institute, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia., Hogden JP; The Eye Health Centre, Brisbane, Queensland, Australia., Shumack S; Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.; Department of Dermatology, Royal North Shore Hospital, Sydney, New South Wales, Australia., Spelman L; Specialist Connect Services, Brisbane, Queensland, Australia.; Queensland Institute of Dermatology, Brisbane, Queensland, Australia., Sebaratnam DF; Department of Dermatology, Liverpool Hospital, Liverpool, New South Wales, Australia.; Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia., Su CS; Orbit, Plastic and Lacrimal Unit, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.; Victoria Parade Surgery Centre, Melbourne, Victoria, Australia., Katelaris CH; Clinical Immunology and Allergy Unit, Western Sydney University, Campbelltown Hospital, Sydney, New South Wales, Australia.
Jazyk: angličtina
Zdroj: The Australasian journal of dermatology [Australas J Dermatol] 2022 Nov; Vol. 63 (4), pp. 421-436. Date of Electronic Publication: 2022 Sep 20.
DOI: 10.1111/ajd.13924
Abstrakt: Background/objectives: Dupilumab-associated ocular surface disease (DAOSD) is of particular relevance in patients with atopic dermatitis (AD). Guidance on DAOSD assessment and management in the Australian setting is needed to reduce its impact and minimise disruption to treatment.
Methods: A systematic review of the literature was undertaken to identify data pertaining to the incidence, pathophysiology, risk factors and management of DAOSD. A critical review of this literature was used to inform a decision framework for dupilumab-prescribers and develop a graded severity scoring tool to guide appropriate management options.
Results: DAOSD typically emerges within 4 months of commencing dupilumab and the occurrence of new events diminishes over time. The reported incidence varies widely depending on the nature and source of the data: 8.6-22.1% (clinical trials programme), 0.5-70% (real-world data; differences in study size, duration of follow-up, ophthalmologist intervention, use of prophylaxis). Occurrence increases with AD severity and in patients with prior history of ocular disease; pathophysiology is still to be fully characterised. Management options have evolved over time and include lubricants/artificial tears, corticosteroids, calcineurin inhibitors, antihistamines, anti-inflammatory agents and antimicrobial agents. Current therapies aim to resolve symptoms or reduce severity to levels sufficiently tolerable to enable continuation of dupilumab therapy.
Conclusions: Recommendations for DAOSD assessment and management include identification of high-risk patients, vigilance for red flags (keratoconus, herpetic and bacterial keratitis), regular assessment of symptom severity (before and during dupilumab therapy), conservative management of mild DAOSD by the prescribing physician and ophthalmologist referral for collaborative care of moderate-severe DAOSD and high-risk patients.
(© 2022 The Authors. Australasian Journal of Dermatology published by John Wiley & Sons Australia, Ltd on behalf of Australasian College of Dermatologists.)
Databáze: MEDLINE
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