Continuing their discussion about safety, Andrew F. Alexis, MD, MPH, and Benjamin N. Lockshin, MD, take a closer look at conjunctivitis data from the long-term use of dupilumab
Andrew F. Alexis, MD, MPH: Going back to safety, I wonder what your opinion is if a patient has a known history of conjunctivitis. How much does that impact your decision on whether you would prescribe dupilumab, whether you’d consider the patient a candidate for it? Does it play a role?
Benjamin N. Lockshin, MD: At least in my practice, conjunctivitis [is] more of an annoyance than something that will significantly influence my decision to prescribe dupilumab. When thinking about medications, I think about this Venn diagram that encompasses 5 components: safety, efficacy, legacy, durability, and access. Can we get the medication? For safety, when you think of all the adverse events of various products as a gestalt and think about how the adverse event profile of dupilumab weighs in, I would say it’s got an incredibly clean and easy-to-articulate safety profile. The only times that I stop or discuss with patients about discontinuing dupilumab is if they’ve had significant and recurrent episodes of conjunctivitis or keratitis. Once again, it’s a joint decision between the 2 of us to decide what to do at that point. It should be noted that as I mentioned earlier, about 25% of the patients have a history of allergic conjunctivitis. I tend to be a caveman, that is the truth. I don’t prophylactically treat with lubricating eyedrops. I tell patients…if you experience red, burning eyes, because I like to speak in patient terms rather than in medical terms, conjunctivitis or keratitis, let me know; I’ve got a good ophthalmologist, or zero ophthalmologists [are needed] at this point. I think they know what they’re doing a lot better than I do. I did do 1 day of [ophthalmology], by no means am I [an] expert, and I realized it was a very tedious specialty in dermatology and certainly something that lends itself more toward what I wanted to do. What do you think about the conjunctivitis signal? Does it change how you approach patient selection now that we have multiple therapies to choose from?
Andrew F. Alexis, MD, MPH: I have a very similar approach. It comes down to discussing that risk with patients and arriving at a shared decision as to whether that patient and I are comfortable with the balance of risk-to-benefit of being on the drug. If they report that they had a prior history of some mild conjunctivitis, maybe they’re likely come to a conclusion that it would be fine to balance the risk-to-benefit profile and go forward with dupilumab, and should conjunctivitis occur, we would manage it accordingly. However, if someone had very severe conjunctivitis, maybe active right at the time, then we would be less inclined to initiate dupilumab and [might] consider a different option. It’s going to be patient-specific and, at the end of the day, a shared decision between the 2 of us.
TRANSCRIPT EDITED FOR CLARITY