Why does Dupixent cause eye problems?

Dupixent (dupilumab) is associated with several different eye problems, including conjunctivitis, blepharitis, dry eyes, itchy eyes, and keratitis. The cause of the eye problems is likely to be the same mechanism that makes Dupixent effective against atopic dermatitis (AD), asthma, and other conditions.

Dupixent is a human monoclonal IgG4 antibody that works by blocking two inflammatory proteins, called interleukin-4 (IL-4) and interleukin-13 (IL-13). Unfortunately, goblet cells, which are responsible for creating mucus in the eye and ensuring the stability of tears, are also stimulated by IL-13. So when Dupixent blocks IL-13 which helps resolve the symptoms of AD and asthma, it also lowers the numbers of epithelial goblet cells, leading to inflammation and eye problems.

Most of the time the inflammation is not too severe, but in some people, Dupixent may need to be discontinued. Most eye problems respond to standard treatments (eg, ophthalmic antibiotics for bacterial conjunctivitis). Eye problems reported with Dupixent include:

• Conjunctivitis (inflammation of the conjunctiva [Linin] of the eye) which includes conjunctivitis due to allergic, bacterial, or viral causes, giant papillary conjunctivitis, eye irritation, and eye inflammation experienced by 10% of people
• Itchy eyes, experienced by 1% of people
• Dry eye, experienced by less than 1% of people
• Blepharitis (inflammation along the edges of the eyelids), experienced by less than 1% of people
• Keratitis (inflammation of the cornea), experienced by less than 1% of people.

Dupixent is a biologic that may be used to treat moderate-to-severe AD in adults and children aged 6 months and older whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. It may also be used to treat moderate-to-severe asthma in adults and children aged 6 years and older in addition to other therapies; eosinophilic esophagitis in adults and children aged 12 years and older, weighing at least 40 kg; chronic rhinosinusitis with nasal polyposis in adults; and to significantly reduce itch and skin lesions in adults with prurigo nodularis.