From the Journals

Eye disease affects 1 in 5 adults with severe atopic dermatitis


Key clinical point: Conjunctivitis, keratitis, and keratoconus are common in patients with atopic dermatitis, compared with the general population

Major finding: 19% of adults with severe AD received a prescription for an anti-inflammatory eye medication, compared with 4.5% of the general population.

Data source: Epidemiologic data from more than 4 million patients in Danish health care and prescription registries.

Disclosures: Four investigators disclosed outside grant funding and/or financial relationships with pharmaceutical manufacturers.



Results of a large cohort study in Denmark found that adults with atopic dermatitis (AD) were significantly more likely to be affected by certain ocular conditions, compared with those who did not have AD.

“Keratitis, conjunctivitis, and keratoconus as well as cataracts in patients younger than 50 years occurred more frequently in patients with AD and in a disease severity–dependent manner,” concluded the authors, who wrote that as far as they know, this is the largest study conducted to date of ocular disorders in adults with AD.

Dr. Jacob Thyssen
Dr. Jacob Thyssen
The findings, published in June, are based on a population-based sample of 4.25 million adults in Denmark, using national health care and prescription registries, of whom 5,766 had been diagnosed with mild AD and another 4,272 with severe AD. The researchers, led by Jacob Thyssen, MD, PhD, of the department of dermatology and allergy, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark, found that 12% of patients with mild AD and 19% of those with severe AD were prescribed at least one anti-inflammatory ocular medication commonly used to treat conjunctivitis or keratitis, compared with only 4.5% of those without AD (J Am Acad Dermatol. 201 Aug;77[2]:280-6).

The investigators also found an elevated risk of a keratitis diagnosis among patients with mild AD (hazard ratio, 1.66; 95% confidence interval, 1.15-2.40) and those with severe AD (HR, 3.17; 95% CI, 2.31-4.35). Severe AD was associated with an elevated risk of keratoconus (HR, 10.01; 95% CI, 5.02-19.96),

Cataracts and glaucoma were not more common among those with AD overall. However, cataracts were increased among those under age 50 years with mild and severe AD, which were significant associations for both, but not among those over age 50 with AD. There were no differences for glaucoma risk associated with AD by age.

The investigators acknowledged that the study could not capture the reasons why anti-inflammatory ocular medicines were prescribed and that such medicines could have been prescribed for conditions other than the ocular conditions.

Capturing the risk of ocular diseases in AD is important, they wrote. They referred to “emerging concern” about the incidence of conjunctivitis with “near-future” biologic treatments for AD and the potential for long-term consequences. They referred to adverse event data from randomized clinical trials of dupilumab, an interleukin-4 receptor–alpha antagonist, approved by the Food and Drug Administration in March 2017 for treatment of moderate to severe AD, which included more cases of conjunctivitis among those treated with the biologic, compared with those on placebo (N Engl J Med. 2016 Dec 15;375:2335-48). A “weak trend” for more cases of conjunctivitis was also reported among treated patients with an IL-13 inhibitor, lebrikizumab, in a phase 2 study of adults with AD, they wrote.

Treatments targeting IL-4 receptor–alpha have been shown to result in increased blood eosinophil counts, and “these elevations might have clinical effects,” Dr. Thyssen and his colleagues wrote, adding: “Notably, eosinophils are pathognomonic for allergic eye disease.”

Dr. Thyssen disclosed funding from the Lundbeck Foundation and honoraria from Roche, Sanofi Genzyme, and LEO Pharma. Three other authors on the study reported research funding and/or honoraria from pharmaceutical firms.

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