Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Kraff Eye Institute, Chicago, Illinois.
JAMA Dermatol. 2018 Oct 1;154(10):1208-1211. doi: 10.1001/jamadermatol.2018.2690.
Clinical trials of dupilumab for atopic dermatitis (AD) have reported an increased incidence of conjunctivitis in patients who received dupilumab compared with those who received placebo.
To describe the characteristics of patients who develop conjunctivitis secondary to dupilumab treatment for AD.
DESIGN, SETTING, AND PARTICIPANTS: Case series of 12 patients who reported development of conjunctivitis from a cohort of 142 patients treated with dupilumab for AD at a secondary care center from March 14, 2017, to March 29, 2018.
Patients received a 600-mg injection of dupilumab as a loading dose and a 300-mg injection every 2 weeks thereafter.
Primary outcome measures were severity of AD as measured by the Investigator Global Assessment (IGA) score, a 5-point scale from 0 (clear) to 4 (severe), at the time of dupilumab initiation and at conjunctivitis onset.
Of the 12 patients included in this series, 7 (58%) were male. The mean (SD) age of patients was 30 (8.1) years at the time conjunctivitis developed. All patients showed improvement of their AD at the time of conjunctivitis diagnosis, with a mean (SD) 1.9 (0.8)-point decrease in IGA score and 47.8% (11.2%) decrease in body surface area affected. Nine of the 12 patients (75%) had severe baseline AD with an IGA score of 4. All patients who discontinued treatment had severe AD at the time of initial dupilumab administration and had at least 1 atopic condition in addition to AD.
Conjunctivitis that develops after administration of dupilumab to treat AD may be severe enough to necessitate stopping therapy. Severe conjunctivitis was more likely to develop in patients with more severe baseline AD who had a good response to dupilumab and an increased atopic phenotype. Studies are needed to confirm risk factors associated with development of conjunctivitis and to determine effective treatment.
针对特应性皮炎（AD）的度普利尤单抗临床试验报告称，与安慰剂组相比，接受度普利尤单抗治疗的患者发生结膜炎的发生率增加。
描述继发于 AD 患者接受度普利尤单抗治疗后出现结膜炎的患者的特征。
设计、地点和参与者： 对 2017 年 3 月 14 日至 2018 年 3 月 29 日在二级护理中心接受度普利尤单抗治疗的 142 名 AD 患者队列中出现结膜炎的 12 名患者进行了病例系列研究。
患者接受 600mg 度普利尤单抗负荷剂量注射，此后每 2 周接受 300mg 注射。
主要结局指标是在开始使用度普利尤单抗和出现结膜炎时，通过研究者全球评估（IGA）评分来衡量 AD 的严重程度，IGA 评分为 0（清除）至 4（严重）的 5 分制。
在本系列研究中纳入的 12 名患者中，有 7 名（58%）为男性。在出现结膜炎时，患者的平均（SD）年龄为 30（8.1）岁。所有患者在诊断为结膜炎时均显示 AD 改善，IGA 评分平均（SD）下降 1.9（0.8）分，受累体表面积减少 47.8%（11.2%）。12 名患者中有 9 名（75%）基线 AD 严重，IGA 评分为 4。所有停止治疗的患者在初始度普利尤单抗给药时均患有严重 AD，并且除 AD 外还有至少 1 种特应性疾病。
在 AD 患者接受度普利尤单抗治疗后出现的结膜炎可能严重到需要停止治疗。基线 AD 更严重、对度普利尤单抗有良好反应且特应性表型增加的患者更有可能发生严重结膜炎。需要进行研究以确认与结膜炎发生相关的危险因素，并确定有效治疗方法。
