Long‐Term Ocular Outcomes of Dupilumab in Atopic Dermatitis: Results From the BioDay Registry
5 affiliations
- 1Department of Dermatology and Allergology National Expertise Center for Atopic Dermatitis University Medical Center Utrecht Utrecht the Netherlands
- 2Department of Ophthalmology University Medical Center Utrecht Utrecht the Netherlands
- 3Center for Translational Immunology University Medical Center Utrecht Utrecht University Utrecht the Netherlands
- 4Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht the Netherlands
- 5Division Laboratories, Pharmacy and Biomedical Genetics Department of Clinical Pharmacy University Medical Center Utrecht Utrecht University Utrecht the Netherlands
Abstract
Background Dupilumab‐associated ocular surface disease (DAOSD) is the most reported side effect in dupilumab‐treated atopic dermatitis (AD) patients. We investigated the effect of long‐term dupilumab treatment on ocular surface disease (OSD), conjunctival goblet cells (GCs), and tear fluid dupilumab levels and proteins. Methods This prospective study included moderate‐to‐severe AD patients at the University Medical Center Utrecht, the Netherlands. Patients initiating dupilumab between February 2020–October 2022 were eligible to participate in scheduled ophthalmological examinations alongside routine dermatological examinations at baseline, week 28, and last follow‐up (≥ 2 years). OSD severity was assessed using the Utrecht Ophthalmic Inflammatory and Allergic disease (UTOPIA) score, with DAOSD defined as a ≥ 3‐point increase from baseline. Conjunctival GC quantity and function were assessed with impression cytology. Dupilumab levels and proteins were measured in tear fluid. Results Forty‐four patients were included. OSD was present in 90.9% (n = 40/44) of patients at all visits. DAOSD occurred in 22.7% (n = 10/44) of patients; 40.0% (n = 4/10) persisted or newly developed at last follow‐up. Tear break‐up time decreased while tear production increased. Tear fluid dupilumab levels and AD‐related inflammatory proteins decreased over time. Conjunctival GCs decreased at last follow‐up compared to baseline. Mucin5AC (MUC5AC) production in CK19‐CD45‐MUC5AC + cells decreased at week 28 and remained stable at last follow‐up. Conclusion OSD remained common during long‐term dupilumab treatment in AD patients. Some patients developed worsening of OSD compatible with DAOSD, including delayed onset, highlighting the need for continued awareness of ocular side effects among clinicians. Reduced MUC5AC production and declining AD‐related inflammatory proteins in tear fluid suggest changes in conjunctival homeostasis and ocular inflammation.
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BibTeX
@article{veldhuis2026longterm,
title = {{Long‐Term Ocular Outcomes of Dupilumab in Atopic Dermatitis: Results From the BioDay Registry}},
author = {Nienke Veldhuis and Roselie E. Achten and Chantal M. vanLuijk and Marlot M. van derWal and Constance F. denHartog Jager and Nicolaas P. A. Zuithoff and Mohsin El Amrani and Edward F. Knol and Femke vanWijk and Marlies deGraaf and Inge M. Haeck and Mor M. Dickman and Marjolein S. deBruin‐Weller},
journal = {Clinical and Translational Allergy},
year = {2026},
month = oct,
doi = {10.1002/clt2.70208},
url = {https://doi.org/10.1002/clt2.70208},
note = {CC BY},
}
RIS
TY - JOUR
TI - Long‐Term Ocular Outcomes of Dupilumab in Atopic Dermatitis: Results From the BioDay Registry
AU - Nienke Veldhuis
AU - Roselie E. Achten
AU - Chantal M. vanLuijk
AU - Marlot M. van derWal
AU - Constance F. denHartog Jager
AU - Nicolaas P. A. Zuithoff
AU - Mohsin El Amrani
AU - Edward F. Knol
AU - Femke vanWijk
AU - Marlies deGraaf
AU - Inge M. Haeck
AU - Mor M. Dickman
AU - Marjolein S. deBruin‐Weller
PY - 2026
DA - 2026/10/28
JO - Clinical and Translational Allergy
DO - 10.1002/clt2.70208
UR - https://doi.org/10.1002/clt2.70208
AB - Background Dupilumab‐associated ocular surface disease (DAOSD) is the most reported side effect in dupilumab‐treated atopic dermatitis (AD) patients. We investigated the effect of long‐term dupilumab treatment on ocular surface disease (OSD), conjunctival goblet cells (GCs), and tear fluid dupilumab levels and proteins. Methods This prospective study included moderate‐to‐severe AD patients at the University Medical Center Utrecht, the Netherlands. Patients initiating dupilumab between February 2020–October 2022 were eligible to participate in scheduled ophthalmological examinations alongside routine dermatological examinations at baseline, week 28, and last follow‐up (≥ 2 years). OSD severity was assessed using the Utrecht Ophthalmic Inflammatory and Allergic disease (UTOPIA) score, with DAOSD defined as a ≥ 3‐point increase from baseline. Conjunctival GC quantity and function were assessed with impression cytology. Dupilumab levels and proteins were measured in tear fluid. Results Forty‐four patients were included. OSD was present in 90.9% (n = 40/44) of patients at all visits. DAOSD occurred in 22.7% (n = 10/44) of patients; 40.0% (n = 4/10) persisted or newly developed at last follow‐up. Tear break‐up time decreased while tear production increased. Tear fluid dupilumab levels and AD‐related inflammatory proteins decreased over time. Conjunctival GCs decreased at last follow‐up compared to baseline. Mucin5AC (MUC5AC) production in CK19‐CD45‐MUC5AC + cells decreased at week 28 and remained stable at last follow‐up. Conclusion OSD remained common during long‐term dupilumab treatment in AD patients. Some patients developed worsening of OSD compatible with DAOSD, including delayed onset, highlighting the need for continued awareness of ocular side effects among clinicians. Reduced MUC5AC production and declining AD‐related inflammatory proteins in tear fluid suggest changes in conjunctival homeostasis and ocular inflammation.
SN - 2045-7022
ER -