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New Recommendations for DAOSD Assessment and ManagementA new studyinto dupilumab-associated ocular surface disease (DAOSD), a known side-effect of dupilumab, prescribed for patients with atopic dermatitis (AD), has been published in the Australasian Journal of Dermatology. A critical review of the literature, concerning incidence, pathophysiology, risk factors and management of DAOSD, was undertaken to inform a management framework for dupilumabprescribers and develop a graded severity scoring tool to guide appropriate management options.The paper aims to provide guidance on the assessment and management of DAOSD to reduce its impact and minimise the disruption to treatment.
The management framework provides an overview of key considerations for prescribing clinicians, and a DAOSA Activity Questionnaire has been proposed to aid in the assessment and grading of eye symptom severity.
The proposed recommendations for DAOSD assessment and management in the Australian setting include identification of high-risk patients, vigilance for red flags (herpetic and bacterial keratitis, and keratoconus), regular assessment of symptom severity (before and during dupilumab therapy), conservative management of mild DAOSD by the prescribing physician, and ophthalmologist referral for collaborative care of moderate–severe DAOSD and high-risk patients.
The aim of these recommendations is to ensure patients are assessed and managed appropriately to reduce the impact of DAOSD and minimise disruption to dupilumab therapy.
DAOSD typically emerges within four months of commencing dupilumab and the occurrence of new events diminishes over time. It encompasses periorbital skin changes and conjunctival cicatrisation, associated with conjunctivitis.
In Australia, dupilumab is indicated for use in moderate to severe atopic dermatitis (AD; patients ≥12 years), severe AD (patients 6–11 years), moderate to severe asthma with type 2 inflammation (patients ≥6 years) and chronic rhinosinusitis with nasal polyps (CRSwNP; patients ≥18 years).
For more information, and to access the assessment and management tools, the paper, Dupilumab-associated ocular surface disease: An interdisciplinary decision framework for prescribers in the Australian setting, can be accessed at onlinelibrary.wiley.com/doi/ 10.1111/ajd.13924.
Reference Foley, P, Kerdraon, YA, Hogden, et al. Dupilumab-associated ocular surface disease: An interdisciplinary decision framework for prescribers in the Australian setting. Australas J Dermatol. 2022; 00: 1– 16. https://doi.org/10.1111/ajd.13924