Adverse Effects of Dupilumab

Common Adverse Effects

Conjunctivitis occurs in 6-15% of patients in clinical trials and up to 26.1% in real-world studies, according to the British Journal of Dermatology 1, 2
Dry eyes are reported in 13% of all treated patients and 36% of those with ocular complications, as noted in the British Journal of Dermatology 3
Keratitis is observed in 11% of all patients and 38% of those with ocular issues, as reported in the British Journal of Dermatology 3
Blepharitis affects 8% of all patients and 29% of those with ocular complications, according to the British Journal of Dermatology 3
Ocular surface disorders typically present with bilateral conjunctival and limbal injection, watery or mucous discharge, and follicular, papillary, or cicatrizing conjunctival changes, as described in Ophthalmology 4, 5

Most ocular complications are mild to moderate in severity and present within weeks to months of starting treatment, as noted in Ophthalmology 4, 5
Many cases are manageable with treatment while continuing dupilumab, according to Ophthalmology 4, 5
Risk factors for ocular complications include a history of atopic conjunctivitis, as reported in Ophthalmology 5
Preservative-free ocular lubricants and topical antihistamine eyedrops are first-line treatments, as recommended by Praxis Medical Insights 6
Urgent ophthalmological referral is needed for worsening visual acuity, ocular pain, sensitivity to light, or visible corneal damage, as noted in the British Journal of Dermatology 3, 5

Despite adverse effects, dupilumab has an excellent overall safety profile with over 10 years of follow-up data, as reported in the British Journal of Dermatology and Praxis Medical Insights 1, 2, 6
Only 4.2% of patients discontinue dupilumab due to ocular complications, according to the British Journal of Dermatology 1, 2
Unilateral eye symptoms are very unlikely to be dupilumab-related and should be managed through existing pathways, as noted in the British Journal of Dermatology 3
Patients should be advised to avoid environments with ocular irritants, such as smoke, pollution, or cooling fans, as recommended in the British Journal of Dermatology 3

The British Journal of Dermatology recommends monitoring for ocular symptoms, including conjunctivitis, keratitis, dry eyes, and blepharitis, which occur in approximately 25% of treated individuals, typically within the first 4 months of treatment 7
The British Journal of Dermatology suggests evaluating for redness, irritation, discharge, foreign body sensation, and visual changes at each follow-up visit 8

Patients with a history of atopic conjunctivitis, keratitis, or other ocular surface disorders have a higher risk of developing dupilumab-related ocular surface disorders (DROSD), according to the British Journal of Dermatology 7

The British Journal of Dermatology recommends initiating preservative-free ocular lubricants as first-line treatment for mild-to-moderate ocular symptoms 8
For severe ocular symptoms, the British Journal of Dermatology suggests urgent ophthalmology referral within 24 hours if decreased visual acuity occurs 7

The British Journal of Dermatology reports that dupilumab most commonly causes ocular surface disorders in 10-42% of patients with atopic dermatitis, with injection site reactions, upper respiratory tract infections, and facial redness being other frequent side effects 9, 10, 11
Eye-related side effects are the most clinically significant adverse events, occurring in 10.9% of clinical trial patients and 20.6-25.1% in real-world cohorts, according to the British Journal of Dermatology 11
Important ocular side effects occur specifically in atopic dermatitis patients, NOT in patients using dupilumab for asthma, chronic rhinosinusitis, or eosinophilic esophagitis, as noted by the British Journal of Dermatology 10, 11

The British Journal of Dermatology recommends seeking emergency ophthalmology evaluation within 24 hours if patients have eye redness PLUS any of the following symptoms: loss of visual acuity, ocular pain, photophobia, or visible corneal damage 9

Patients at highest risk for developing eye problems include those with a history of pre-existing dry eye disease with keratitis (OR 6.3, 95% CI 1.3-31.6), as reported by the British Journal of Dermatology 10
Any prior eye disease (OR 2.97, 95% CI 1.76-5.01) is also a risk factor, according to the British Journal of Dermatology 11
Prior use of ophthalmic medications (OR 5.16, 95% CI 3.11-8.58) increases the risk of ocular side effects, as noted by the British Journal of Dermatology 9