Abordagem da conjuntivite em paciente com dermatite atópica em uso de dupilumabe
Management of conjunctivitis in patients with atopic dermatitis using dupilumab
Mara Giavina-Bianchi; Pedro Giavina-Bianchi
Resumo
O dupilumabe foi aprovado para o tratamento de dermatite atópica moderada a grave em adultos e adolescentes no Brasil. Ensaios clínicos e estudos de vida real mostraram alta eficácia e segurança deste imunobiológico, porém a frequência de conjuntivite no grupo de pacientes com dermatite atópica tratado com esse medicamento foi mais alta do que no grupo controle. A conjuntivite é mais frequente em pacientes com dermatite atópica do que na população geral, e foi o efeito adverso mais frequente nos pacientes com dermatite atópica em uso do dupilumabe. A maioria dos casos apresentou quadro leve, sem necessidade de suspender a medicação. Apresentamos uma sugestão de algoritmo para a abordagem da conjuntivite nos pacientes em uso do dupilumabe para tratamento da dermatite atópica.
Palavras-chave
Abstract
Dupilumab has been approved for the treatment of moderate to severe atopic dermatitis in adults and adolescents in Brazil. Clinical trials and real-life studies have demonstrated the high efficacy and safety of this immunobiological agent, but the frequency of conjunctivitis in the group of patients treated with this drug for atopic dermatitis has been higher than that in the control group. Conjunctivitis is more common in patients with atopic dermatitis than in the general population, and it has been reported as the most common adverse effect in patients with atopic dermatitis using dupilumab. Most cases are of mild severity, without the need to discontinue medication. We suggest an algorithm for the management of conjunctivitis in patients treated with dupilumab for atopic dermatitis.
Keywords
Referências
1. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I. J Eur Acad Dermatol Venereol. 2018;32(5):657-82.
2. Wollenberg A, Barbarot S, Bieber T, Christen-Zaech S, Deleuran M, Fink-Wagner A, et al. Consensus-based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part II. J Eur Acad Dermatol Venereol. 2018;32(6):850-78.
3. Kay J, Gawkrodger DJ, Mortimer MJ, Jaron AG. The prevalence of childhood atopic eczema in a general population. J Am Acad Dermatol. 1994;30(1):35-9.
4. Silverberg JI, Hanifin JM. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol. 2013;132(5):1132-8.
5. Giavina Bianchi M, Santos AP, Cordioli E. The majority of skin lesions in pediatric primary care attention could be managed by Teledermatology. PLoS One. 2019;14(12):e0225479.
6. Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Symptoms and diagnosis of anxiety and depression in atopic dermatitis in U.S. adults. Br J Dermatol. 2019;181(3):554-65.
7. Campos ALB, Araújo FM, Santos MALD, Santos AASD, Pires CAA. Impact of atopic dermatitis on the quality of life of pediatric patients and their guardians. Rev Paul Pediatr. 2017;35(1):5-10.
8. Czarnowicki T, He H, Krueger JG, Guttman-Yassky E. Atopic dermatitis endotypes and implications for targeted therapeutics. J Allergy Clin Immunol. 2019;143(1):1-11.
9. Wu KK, Borba AJ, Deng PH, Armstrong AW. Association between atopic dermatitis and conjunctivitis in adults: a population-based study in the United States. J Dermatolog Treat. 2019 Sep 2:1-5. doi: 10.1080/09546634.2019.1659480.
10. Shokouhi Shoormasti R, Pourpak Z, Fazlollahi MR, Kazemnejad A, Nadali F, Ebadi Z, et al. The Prevalence of Allergic Rhinitis, Allergic Conjunctivitis, Atopic Dermatitis and Asthma among Adults of Tehran. Iran J Public Health. 2018;47(11):1749-55.
11. Thyssen JP, Toft PB, Halling-Overgaard AS, Gislason GH, Skov L, Egeberg A. Incidence, prevalence, and risk of selected ocular disease in adults with atopic dermatitis. J Am Acad Dermatol. 2017;77(2):280-6.e1.
12. Schneider L, Hanifin J, Boguniewicz M, Eichenfield LF, Spergel JM, Dakovic R, et al. Study of the Atopic March: Development of Atopic Comorbidities. Pediatr Dermatol. 2016;33(4):388-98.
13. Henriksen L, Simonsen J, Haerskjold A, Linder M, Kieler H, Thomsen SF, et al. Incidence rates of atopic dermatitis, asthma, and allergic rhinoconjunctivitis in Danish and Swedish children. J Allergy Clin Immunol. 2015;136(2):360-6.e2.
14. Stensballe LG, Klansø L, Jensen A, Haerskjold A, Thomsen SF, Simonsen J. The validity of register data to identify children with atopic dermatitis, asthma or allergic rhinoconjunctivitis. Pediatr Allergy Immunol. 2017;28(6):535-42.
15. Yokoi K, Yokoi N, Kinoshita S. Impairment of ocular surface epithelium barrier function in patients with atopic dermatitis. Br J Ophthalmol. 1998;82(7):797-800.
16. Mantelli F, Mauris J, Argüeso P. The ocular surface epithelial barrier and other mechanisms of mucosal protection: from allergy to infectious diseases. Curr Opin Allergy Clin Immunol. 2013;13(5):563-8.
17. Bostock J. Case of a Periodical Affection of the Eyes and Chest. Med Chir Trans. 1819;10(Pt 1):161-5.
18. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet. 1998;351(9111):1225-32.
19. Cronau H, Kankanala RR, Mauger T. Diagnosis and management of red eye in primary care. Am Fam Physician. 2010;81(2):137-44.
20. Wenzel S, Ford L, Pearlman D, Spector S, Sher L, Skobieranda F, et al. Dupilumab in persistent asthma with elevated eosinophil levels. N Engl J Med. 2013;368(26):2455-66.
21. Guttman-Yassky E, Bissonnette R, Ungar B, Suárez-Fariñas M, Ardeleanu M, Esaki H, et al. Dupilumab progressively improves systemic and cutaneous abnormalities in patients with atopic dermatitis. J Allergy Clin Immunol. 2019;143(1):155-72.
22. Simpson EL, Paller AS, Siegfried EC, Boguniewicz M, Sher L, Gooderham MJ, et al. Efficacy and Safety of Dupilumab in Adolescents With Uncontrolled Moderate to Severe Atopic Dermatitis: A Phase 3 Randomized Clinical Trial. JAMA Dermatol. 2019 Nov 6. doi: 10.1001/jamadermatol.2019.3336.
23. Simpson EL, Bieber T, Guttman-Yassky E, Beck LA, Blauvelt A, Cork MJ, et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med. 2016;375(24):2335-48.
24. Blauvelt A, de Bruin-Weller M, Gooderham M, Cather JC, Weisman J, Pariser D, et al. Long-term management of moderate-tosevere atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet. 2017;389(10086):2287‑303.
25. Faiz S, Giovannelli J, Podevin C, Jachiet M, Bouaziz JD, Reguiai Z, et al. Effectiveness and safety of dupilumab for the treatment of atopic dermatitis in a real-life French multicenter adult cohort. J Am Acad Dermatol. 2019;81(1):143-51.
26. Giavina-Bianchi M, Rizzo LV, Giavina-Bianchi P. Severe atopic dermatitis: Dupilumab is not just safer, but more efficient. Allergol Immunopathol (Madr). No prelo 2020.
27. Giavina-Bianchi MH, Giavina-Bianchi P, Rizzo LV. Dupilumab in the treatment of severe atopic dermatitis refractory to systemic immunosuppression: case report. Einstein (Sao Paulo). 2019;17(4):eRC4599.
28. Wollenberg A, Ariens L, Thurau S, van Luijk C, Seegräber M, de Bruin-Weller M. Conjunctivitis occurring in atopic dermatitis patients treated with dupilumab-clinical characteristics and treatment. J Allergy Clin Immunol Pract. 2018;6(5):1778-80.e1.
29. Shen J, Lei QQ, Chen X, Cao C, Cen Y. Diagnostic performance of micropthalmia transcription factor for melanoma: a systematic review and meta-analysis. Eur Rev Med Pharmacol Sci. 2014;18(6):798‑805.
30. Barnes AC, Blandford AD, Perry JD. Cicatricial ectropion in a patient treated with dupilumab. Am J Ophthalmol Case Rep. 2017;7:120-2.
31. Treister AD, Kraff-Cooper C, Lio PA. Risk Factors for DupilumabAssociated Conjunctivitis in Patients With Atopic Dermatitis. JAMA Dermatol. 2018;154(10):1208-11.
32. Maudinet A, Law-Koune S, Duretz C, Lasek A, Modiano P, Tran THC. Ocular Surface Diseases Induced by Dupilumab in Severe Atopic Dermatitis. Ophthalmol Ther. 2019;8(3):485-90.
33. Gooderham M, McDonald J, Papp K. Diagnosis and Management of Conjunctivitis for the Dermatologist. J Cutan Med Surg. 2018;22(2):200-6.
34. Akinlade B, Guttman-Yassky E, de Bruin-Weller M, Simpson EL, Blauvelt A, Cork MJ, et al. Conjunctivitis in dupilumab clinical trials. Br J Dermatol. 2019;181(3):459-73.
35. Thyssen JP, de Bruin-Weller MS, Paller AS, Leshem YA, Vestergaard C, Deleuran M, et al. Conjunctivitis in atopic dermatitis patients with and without dupilumab therapy - international eczema council survey and opinion. J Eur Acad Dermatol Venereol. 2019;33(7):1224-31.
36. Uchio E, Miyakawa K, Ikezawa Z, Ohno S. Systemic and local immunological features of atopic dermatitis patients with ocular complications. Br J Ophthalmol. 1998;82(1):82-7.
37. Wenzel S, Castro M, Corren J, Maspero J, Wang L, Zhang B, et al. Dupilumab efficacy and safety in adults with uncontrolled persistent asthma despite use of medium-to-high-dose inhaled corticosteroids plus a long-acting β2 agonist: a randomised doubleblind placebo-controlled pivotal phase 2b dose-ranging trial. Lancet. 2016;388(10039):31-44.
38. Rabe KF, Nair P, Brusselle G, Maspero JF, Castro M, Sher L, et al. Efficacy and Safety of Dupilumab in Glucocorticoid-Dependent Severe Asthma. N Engl J Med. 2018;378(26):2475-85.
39. Bachert C, Mannent L, Naclerio RM, Mullol J, Ferguson BJ, Gevaert P, et al. Effect of Subcutaneous Dupilumab on Nasal Polyp Burden in Patients With Chronic Sinusitis and Nasal Polyposis: A Randomized Clinical Trial. JAMA. 2016;315(5):469-79.
40. Hirano I, Dellon ES, Hamilton JD, Collins MH, Peterson K, Chehade M, et al. Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis. Gastroenterology. 2020;158(1):111-22.e10.
41. Thyssen JP. Could conjunctivitis in patients with atopic dermatitis treated with dupilumab be caused by colonization with Demodex and increased interleukin-17 levels? Br J Dermatol. 2018;178(5):1220.
42. Bakker DS, Ariens LFM, van Luijk C, van der Schaft J, Thijs JL, Schuttelaar MLA, et al. Goblet cell scarcity and conjunctival inflammation during treatment with dupilumab in patients with atopic dermatitis. Br J Dermatol. 2019;180(5):1248-9.
43. Levine RM, Tattersall IW, Gaudio PA, King BA. Cicatrizing blepharoconjunctivitis occurring during dupilumab treatment and a proposed algorithm for its management. JAMA Dermatol. 2018;154(12):1485-6.
44. Fukuda K, Ishida W, Kishimoto T, Fukushima A. Development of conjunctivitis with a conjunctival proliferative lesion in a patient treated with dupilumab for atopic dermatitis. Allergol Int. 2019;68(3):383-4.
45. Aszodi N, Thurau S, Seegräber M, de Bruin-Weller M, Wollenberg A. Management of dupilumab-associated conjunctivitis in atopic dermatitis. J Dtsch Dermatol Ges. 2019;17(5):488-91.
46. Levine BB. Immunologic mechanisms of penicillin allergy. A haptenic model system for the study of allergic diseases of man. N Engl J Med. 1966;275(20):1115-25.
47. Gooderham M, Lynde CW, Papp K, Bourcier M, Guenther L, Gulliver W, et al. Review of Systemic Treatment Options for Adult Atopic Dermatitis. J Cutan Med Surg. 2017;21(1):31-9.
48. Beck KM, Seitzman GD, Yang EJ, Sanchez IM, Liao W. Ocular CoMorbidities of Atopic Dermatitis. Part II: Ocular Disease Secondary to Treatments. Am J Clin Dermatol. 2019;20(6):807-15.
49. Zirwas MJ, Wulff K, Beckman K. Lifitegrast add-on treatment for dupilumab-induced ocular surface disease (DIOSD): A novel case report. JAAD Case Rep. 2019;5(1):34-6.
50. Ivert LU, Wahlgren CF, Ivert L, Lundqvist M, Bradley M. Eye Complications During Dupilumab Treatment for Severe Atopic Dermatitis. Acta Derm Venereol. 2019;99(4):375-8.
51. Agnihotri G, Shi K, Lio PA. A Clinician's Guide to the Recognition and Management of Dupilumab-Associated Conjunctivitis. Drugs R D. 2019;19(4):311-8.
Submetido em:
04/12/2019
Aceito em:
16/12/2019
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