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Dermbits

MD, MPH

How do you manage conjunctivitis that occurs while on dupilumab?

Atopic Dermatitis

You. So conjunctivitis is a known comorbidity of AD patients. And really regardless of therapy. And the risk factors for conjunctivitis include history of severe atopic dermatitis or really just a past history of conjunctivitis. And in dupilamab trials, conjunctivitis occurred in about seven to 12% of patients that were treated with dupilamab, compared to about 2% on placebo. So when I think about patients who later may present with conjunctivitis, I really think about classifying them into the more mild to moderate versus a bit more severe categories. And I shall say most cases of conjunctivitis that occurred with dupilamab tend to be mild or moderate and can be managed without discontinuation of dupilumab. So for my patients, first of all, what I do is that before I start dupilumab, I have them really just go by some artificial tears. So as they are starting the therapy, they can actually use artificial tears to make sure that their eyes are lubricated. So sort of a preventative measure. And if they do experience mild conjunctivitis, again, the use of artificial tears is really important. And I have them buy those single use twisty tops just to prevent potential for infection by using ones that may be containing large volume. In addition to that, I also recommend the use of if they have some mild conjunctivitis, antihistamine eyedrops. And some of those may include the over the counter antihistamine drops such as padaway or alloy. And if they are more severe, if they have more severe presentations of conjunctivitis, I refer them to ophthalmology immediately. But sometimes there can be a little bit of wait between my referral and when they can actually get to see ophthalmology. So if the wait is a bit long, I oftentimes will prescribe a corticosteroid topical eyedrop. And the one that I like is called fluoromethylone or FML eyedrop. And the reason is because it has poor penetration really into the anterior chamber of the eye. As a result, it has a lower risk of cataracts or glaucoma compared to other types of eyedrops, topical cortical steroid eyedrops and then other options include cyclosporin eyedrops such as things like restasis that you can prescribe until they see ophthalmologist or tacholimus eyedrop or ointment can be super helpful as well. All.

How do you manage conjunctivitis that occurs while on dupilumab?

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