Dupilumab Therapy for Atopic Dermatitis

Efficacy and Safety

The American Academy of Dermatology recommends dupilumab as a first-line biologic therapy for adults with moderate-to-severe atopic dermatitis who have failed topical therapies 2, 3
Dupilumab is recommended as a safe and effective treatment option for patients with moderate-to-severe atopic dermatitis who are already on infliximab, as there are no known significant drug interactions between these biologics 1, 2

Dupilumab-related ocular surface disorders (DROSD) occur in approximately 25% of treated individuals, typically within the first 4 months of treatment 4, 5
Risk factors for developing DROSD include pre-existing ocular surface disorders 6, history of atopic conjunctivitis or keratitis 6, and higher baseline AD severity 4, 6
Patients with pre-existing corneal or conjunctival eye disease should be offered prophylactic preservative-free ocular lubricants before starting dupilumab 4

The standard dosing regimen of dupilumab is 600 mg loading dose, followed by 300 mg every 2 weeks 2, 7
For patients with pre-existing ocular disease, start prophylactic preservative-free ocular lubricants 4, 6
Continue current infliximab regimen as prescribed 3

Assess treatment response at 16 weeks using validated measures (EASI, IGA) 2, 7
Monitor for ocular symptoms at each visit, particularly in the first 4 months 4, 5
For mild-to-moderate ocular symptoms, preservative-free ocular lubricants are typically effective 5, 6
For severe symptoms or if red flags are present, urgent referral to ophthalmology within 24 hours is recommended 4, 6

Do not delay treatment of significant ocular symptoms; early intervention reduces risk of complications 4, 6
Do not discontinue dupilumab prematurely due to mild ocular symptoms, as these can often be managed with lubricants 5
Do not use systemic corticosteroids as long-term therapy for atopic dermatitis, even with inadequate response to dupilumab 8, 9