Gelato Federica, Mastorino Luca, Quaglino Pietro, Cavaliere Giovanni, Ortoncelli Michela, Ribero Simone
From the *Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy.
Dermatitis. 2023 Sep-Oct;34(5):445-447. doi: 10.1089/derm.2022.0063. Epub 2023 Jan 23.
Dupilumab, an interleukin (IL)-4 receptor-α inhibitor that blocks IL-4 and IL-13 signaling pathways, is an effective and well-tolerated therapy for moderate-to-severe atopic dermatitis (AD). However, an increased incidence of dupilumab-associated conjunctivitis has been reported in patients treated with dupilumab. In contrast, upadacitinib, a selective Janus kinase 1 inhibitor, is reported to have lower incidence of conjunctivitis than dupilumab. The aim of this retrospective study was to investigate ocular adverse events in adult patients with moderate-to-severe AD treated with upadacitinib after discontinuing treatment with dupilumab. In total, 33 patients were examined at the start of treatment with upadacitinib after discontinuation of dupilumab, then again after 4 weeks and every 12 weeks up to a maximum of 72 weeks. Among the patients in the study, 14 had developed dupilumab-associated conjunctivitis during dupilumab treatment and had complete resolution of ocular symptoms after the switch to upadacitinib within the 1-month follow-up visit. In addition, only 1 patient treated with upadacitinib developed an episode of conjunctivitis. This condition was of mild severity and it spontaneously resolved quickly. Interestingly, this patient had no history of dupilumab-associated conjunctivitis. All patients who developed dupilumab-associated conjunctivitis experienced complete remission on upadacitinib and only 3% of the patients in our sample developed conjunctivitis after the start of treatment with upadacitinib. In light of this, upadacitinib appears to be a prudent and safe treatment option for AD patients with uncontrolled ocular symptoms associated with dupilumab therapy.
度普利尤单抗是一种白细胞介素（IL）-4受体-α抑制剂，可阻断IL-4和IL-13信号通路，是治疗中度至重度特应性皮炎（AD）的一种有效且耐受性良好的疗法。然而，据报道，接受度普利尤单抗治疗的患者中，与度普利尤单抗相关的结膜炎发病率有所增加。相比之下，选择性Janus激酶1抑制剂乌帕替尼据报道结膜炎发病率比度普利尤单抗低。这项回顾性研究的目的是调查在停用度普利尤单抗后接受乌帕替尼治疗的中度至重度AD成年患者的眼部不良事件。共有33例患者在停用度普利尤单抗后开始接受乌帕替尼治疗时接受检查，然后在4周后再次检查，之后每12周检查一次，最长至72周。在研究患者中，14例在度普利尤单抗治疗期间出现了与度普利尤单抗相关的结膜炎，在改用乌帕替尼后的1个月随访期内眼部症状完全缓解。此外，接受乌帕替尼治疗的患者中只有1例出现了一次结膜炎。这种情况为轻度，且很快自行缓解。有趣的是，该患者没有度普利尤单抗相关结膜炎的病史。所有出现度普利尤单抗相关结膜炎的患者在使用乌帕替尼后均完全缓解，在我们的样本中，只有3%的患者在开始使用乌帕替尼治疗后出现结膜炎。鉴于此，对于因度普利尤单抗治疗而出现眼部症状无法控制的AD患者，乌帕替尼似乎是一种谨慎且安全的治疗选择。
