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Tauber J, Ritterband DC, Kang JJ. Corneal Complications Related to Dupilumab Use. Eye Contact Lens 2024; 50:270-273. [PMID: 38661491 DOI: 10.1097/icl.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES The aim of this report is to describe atypical corneal complications associated with dupilumab use. METHODS This is a series of four cases of adult patients with infiltrative or ulcerative keratitis secondary to dupilumab use. RESULTS All four patients in this series were prescribed dupilumab for the treatment of atopic dermatitis and developed infiltrative or ulcerative corneal lesions. In all cases, corneal disease was successfully managed with immediate discontinuation of dupilumab and topical steroid treatment. In two cases, the patient also received antibiotic eye drops for infection precautions. CONCLUSIONS Although dupilumab is most commonly associated with conjunctivitis, physicians should be aware of potential severe corneal complications for early identification and intervention.
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Affiliation(s)
- Jenna Tauber
- Manhattan Eye, Ear and Throat Hospital/ Northwell Eye Institute (J.T., D.C.R.), New York, NY; and Department of Ophthalmology (J.T., J.J.K.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Dargentolle G, Georges M, Beltramo G, Poisson C, Bonniaud P. [Adverse events in biologics for severe asthma]. Rev Mal Respir 2024; 41:372-381. [PMID: 38653607 DOI: 10.1016/j.rmr.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/22/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Asthma is a pathology that remains severe and is inadequately controlled in 4% of patients. Identification of multiple pathophysiological mechanisms has led to the development of biomedicines, of which there are currently five available in France, with a safety profile that appears favorable but remains uncertain due to a lack of real-life experience with these new molecules. STATE OF KNOWLEDGE Although relatively benign, the adverse effects of biologics are diverse. Headache, joint pain, skin reactions at the injection site, fever and asthenia are commonly observed during the different treatments. Ophthalmological complications seem restricted to dupilumab, with numerous cases of keratitis and conjunctivitis in patients with atopic dermatitis. Several respiratory complications have also been observed, essentially consisting in pharyngitis and other upper respiratory infections. Hypereosinophilia may occur, mainly with dupilumab, requiring investigation of systemic repercussions or vasculitis. Allergic reactions are uncommon but require careful monitoring during initial injections. CONCLUSION Biologics for severe asthma are recent drugs with a favorable safety profile, but with little real-life experience, justifying increased vigilance by prescribing physicians.
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Affiliation(s)
- G Dargentolle
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France
| | - M Georges
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Centre des sciences du goût et de l'alimentation, UMR CNRS 6225, INRA 1324, université de Bourgogne, Dijon, France; UFR des sciences de santé, université de Bourgogne, Dijon, France.
| | - G Beltramo
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Inserm U1231 LNC, équipe HSP-pathies, université de Bourgogne, Dijon, France; F-CRIN, Clinical Research Initiative In Severe Asthma: a Lever for Innovation & Science (CRISALIS), Toulouse, France; UFR des sciences de santé, université de Bourgogne, Dijon, France
| | - C Poisson
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Inserm U1231 LNC, équipe HSP-pathies, université de Bourgogne, Dijon, France
| | - P Bonniaud
- Service de pneumologie et soins intensifs respiratoires, centre de référence constitutif des maladies pulmonaires rares de l'adulte, CHU de Dijon Bourgogne, 14, rue Paul-Gaffarel, 21079 Dijon cedex, France; Inserm U1231 LNC, équipe HSP-pathies, université de Bourgogne, Dijon, France; F-CRIN, Clinical Research Initiative In Severe Asthma: a Lever for Innovation & Science (CRISALIS), Toulouse, France; UFR des sciences de santé, université de Bourgogne, Dijon, France
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Maganti N, Whittier SA, Warner EJ. Peripheral ulcerative keratitis associated with tralokinumab therapy: a case report and review of IL-13 inhibitor-associated ocular surface disease. J Ophthalmic Inflamm Infect 2024; 14:15. [PMID: 38625674 PMCID: PMC11021381 DOI: 10.1186/s12348-024-00394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/23/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Dupilumab and tralokinumab are interleukin-binding monoclonal antibodies used to treat systemic atopic disease. Use of these medications in management of atopic dermatitis (AD) is known to cause conjunctivitis. Dupilumab therapy has also been associated with more severe ocular surface disease, which has not previously been described in association with tralokinumab. This report describes a case of tralokinumab-associated conjunctivitis and peripheral ulcerative keratitis and reviews the spectrum and proposed mechanisms of ocular surface disease triggered by these medications. CASE PRESENTATION A 61-year-old male with no rheumatologic or ocular history presented with bilateral papillary conjunctivitis and right eye peripheral ulcerative keratitis (PUK). PUK was arrested using oral corticosteroids and doxycycline, and long-term control of papillary conjunctivitis was achieved using topical tacrolimus ointment, allowing continuation of effective AD management with tralokinumab. CONCLUSION This case report documents ulcerative keratitis occurring in association with tralokinumab therapy for AD, which has previously been described with dupilumab but not tralokinumab. This report demonstrates the need for vigilant ocular surface monitoring for patients on tralokinumab and illustrates successful management and long-term control of adverse ocular events associated with this medication.
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Affiliation(s)
- Nenita Maganti
- The Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 2870 University Avenue, Suite 206, Madison, WI, 53705, USA
| | - Samuel A Whittier
- The Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 2870 University Avenue, Suite 206, Madison, WI, 53705, USA
| | - Evan J Warner
- The Department of Ophthalmology and Visual Sciences, University of Wisconsin-Madison, 2870 University Avenue, Suite 206, Madison, WI, 53705, USA.
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Tsai JH, Tsai TF. A Review of Dupilumab-Induced Adverse Events to Dermatologists and the Potential Pathogenesis in the Treatment of Atopic Dermatitis. Dermatitis 2024; 35:24-42. [PMID: 37205852 DOI: 10.1089/derm.2022.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Dupilumab, a monoclonal antibody targeting interleukin-4 antibody, is approved for use in many type 2 inflammatory diseases, including atopic dermatitis. It is generally well tolerated with no need of routine laboratory monitoring. However, several adverse events have been reported during real-world practice and in pivotal trials. We conducted a systematic literature research of the PubMed, Medline, and Embase databases to identify articles recording the clinical manifestation and potential pathogenesis of these adverse events with interests (AEIs) to dermatologists. In total, 547 cases from 134 studies have developed 39 AEIs 1 day to 2.5 years after dupilumab treatment. The most common AEIs are facial and neck dermatitis (299 cases), psoriasis (70 cases), arthralgia (56 cases), alopecia (21 cases), cutaneous T cell lymphoma (19 cases), severe ocular diseases (19 cases), and drug eruption (6 cases). Most of the AEIs recorded in this review resolved or improved after dupilumab discontinuation or the addition of another treatment, whereas 3 of the cases died of severe AEI. The potential pathogenesis included T help type 1 (Th1)/T help type 2 (Th2) imbalance, Th2/T help type 17 (Th17) imbalance, immune reconstitution, hypersensitivity reaction, transient hypereosinophilia related, and Th1 suppression. Clinicians should be alert of these AEIs for timely diagnosis and appropriate treatment.
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Affiliation(s)
- Jun-Hong Tsai
- From the Department of Medical Education, National Taiwan University Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital & National Taiwan University, College of Medicine, Taipei, Taiwan
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Fukuda K, Kishimoto T, Sumi T, Yamashiro K, Ebihara N. Biologics for allergy: therapeutic potential for ocular allergic diseases and adverse effects on the eye. Allergol Int 2022; 72:234-244. [PMID: 36333219 DOI: 10.1016/j.alit.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 11/28/2022] Open
Abstract
Biologics applying antibodies against IgE, IL-5, IL-5 receptor α, IL-4 receptor α, and IL-13 have dramatically improved recent treatment outcomes in allergic diseases including asthma, rhinitis, and atopic dermatitis. However, these drugs have not been approved for ocular allergic diseases such as allergic conjunctivitis, vernal keratoconjunctivitis, and atopic keratoconjunctivitis. Although the putative mechanisms suggest that these drugs should have beneficial effects in patients with ocular allergies and some studies have reported such beneficial effects, various adverse ocular symptoms have also been observed in clinical trials and off-label use studies. Since ocular allergic diseases have distinct pathogeneses, each biologic drug must be examined regarding specific effects on each ocular allergy. For example, IgE-mediated type 1 hypersensitivity plays a critical role in allergic conjunctivitis. By contrast, T cells and eosinophilic and non-IgE-mediated type 2 inflammation play important roles in vernal keratoconjunctivitis. Allergists must fully understand the effects of each drug on the eye. This review outlines both potential therapeutic and adverse effects of various biologics on allergic diseases of the eye.
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Affiliation(s)
- Ken Fukuda
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan.
| | - Tatsuma Kishimoto
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Tamaki Sumi
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Kenji Yamashiro
- Department of Ophthalmology and Visual Science, Kochi Medical School, Kochi University, Kochi, Japan
| | - Nobuyuki Ebihara
- Department of Ophthalmology and Visual Science, Juntendo University Urayasu Hospital, Tokyo, Japan
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Hébert M, Qi SR, You E, Mercier M, Laughrea PA. Characterising the chronicity of dupilumab-associated ocular surface disease: an analysis of a retrospective case series. BMJ Open Ophthalmol 2022; 7:bmjophth-2021-000947. [PMID: 36161848 PMCID: PMC9174821 DOI: 10.1136/bmjophth-2021-000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background/aims To describe the clinical presentation and treatment response of dupilumab-associated ocular surface disease (DAOSD). Methods This is a retrospective case series of atopic dermatitis patients with DAOSD treated with dupilumab. All consecutive patients with atopic dermatitis referred by dermatologists for suspicion of DAOSD between May 2018 and June 2020 were systemically assessed by a single ophthalmologist. Presenting signs of DAOSD, duration of treatment and associated response are described. Results Twenty-eight patients had DAOSD during the study period. Average age was 45.6±14.8 years and 13 (46%) were female. Average follow-up was 15±10 months. Most presentations consisted in diffuse, inflammatory conjunctivitis (n=19, 68%). Other signs included peripheral corneal infiltrates (n=7, 25%), limbal nodules (n=7, 25%) and dry eye syndrome (n=6, 21%). To control ocular symptoms, tapering of corticosteroid eyedrops was slow: taper duration of strong and mild corticosteroid eyedrops averaged 10±8 weeks and 49±34 weeks, respectively. Four patients (14%) required an increase of corticosteroid eyedrops during taper due to clinical deterioration. Corticosteroid eyedrops were still required at final follow-up among 10 patients (36%). Dupilumab was temporarily stopped in 3 patients (11%), one of which did not wish to resume dupilumab for unrelated reasons. Symptomatic improvement and/or complete resolution was achieved in 25/26 patients at follow-up (96%) with empirical treatment. Conclusions DAOSD may follow the course of a chronic illness. Long-term corticosteroid eyedrops were required in many patients and when taper was possible, this was done after a prolonged treatment duration. Most patients’ ocular symptoms could be controlled, allowing dupilumab continuation.
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Affiliation(s)
- Mélanie Hébert
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Susan Ruyu Qi
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Eunice You
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Mathieu Mercier
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Patricia-Ann Laughrea
- Department of Ophthalmology, Hôpital du Saint-Sacrement, Centre hospitalier universitaire de Québec-Université Laval, Quebec City, Quebec, Canada
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