Dupilumab-associated ocular surface disease in patients with atopic dermatitis is frequent: a nationwide real world evidence study.

New biologic treatments are increasingly used for the treatment of moderate to severe atopic dermatitis (AD). This study examined clinical characteristics of patients with Dupilumab-associated ocular surface disease (DAOSD). 382 patients were included in a retrospective nationwide cohort study of all Danish adults treated with Dupilumab for AD for more than 16 weeks. The frequency of DAOSD was 37.7% with a median follow-up of 1.6 years. Before initiating treatment, 61.3% of the DOASD-patients already had pre-existing ocular sur-face disease (OSD), why the DAOSD-group was then sub divided in two groups: one with pre-existing OSD and one without pre-existing OSD. Patients who developed DAOSD had a longer median duration of AD (41.5 and 44 for patients with pre-existing OSD and patients without pre-existing OSD) vs. 33 years (non-DAOSD), p=0.005), a higher median reduction in EASI score (93.3% and 90.2% vs. 83.8%, p=0.006) and more frequently rhinitis (49.4% and 52.7% vs. 37.1%, p=0.031). In 75% of cases, DAOSD presented before week nine, conjunctivitis was the most common sign of DAOSD (73.2%) and to treat DAOSD, ophthalmolo-gists prescribed lubricating eye drops to patients with pre-existing OSD and patients without pre-existing OSD drops in 88.5% and 87.3 of the cases, and mild (e.g., hydrocortisone) and strong (e.g., dexamethasone) cortico-steroid eye drops equally frequent (24.1 and 25.3% vs. 16.4% and 29.1%). In 5% of the cohort, Dupilumab treatment was discontinued due to DAOSD (n=19), even though these patients received lubricating eyedrops (84%), mild steroids (41.1) and strong steroids (31.6%). DAOSD should be recognized by dermatologists and should lead to consideration of early referral to ophthalmologists.