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Abstract：
Introduction: Atopic dermatitis (AD) is a prevalent chronic inflammatory skin condition with a substantial impact on patients, particularly due to ocular involvement known as atopic keratoconjunctivitis (AKC). Current therapeutic approaches, such as dupilumab, often lead to conjunctivitis, prompting exploration of alternative treatments like upadacitinib. Methods: We collected dermatological and ophthalmological prospective clinical evaluations of six adults with moderate-to-severe AD, undergoing treatment with upadacitinib after discontinuation of dupilumab due to the onset of AKC during therapy and the worsening of dermatitis in particular in the head and neck region. Clinical evaluations, including EASI scores, itch and sleep NRS, DLQI, and ocular parameters, were performed at baseline (during screening assessment before switching to upadacitinib) and then at week 12 and week 24. Clinical evaluation of AKC was performed by a team of ophthalmologists. Results: Upadacitinib not only improved atopic dermatitis in terms of EASI, itching, and sleep NRS, but also demonstrated a notable reduction in ocular signs and symptoms, as indicated by the Visual Analogue Scale (VAS), the Efron scale, and the Ocular Surface Disease Index Symptom Severity (OSDISS) scores. Discussion: Our observation of common clinical practice underscores the substantial impact of biological and small-molecule therapies on AD, emphasizing the limitation posed by dupilumab-associated conjunctivitis. Switching to upadacitinib significantly improved both clinical and functional ocular outcomes, suggesting its potential as an alternative therapeutic option for AD patients with ocular involvement. Conclusion: The presented data provides insights into the complex interplay between systemic therapies and ocular manifestations in AD. Upadacitinib emerges as a promising option to address dupilumab-associated conjunctivitis, offering improved quality of life for patients.
摘要：
简介：特应性皮炎（AD）是一种常见的慢性炎症性皮肤病，对患者有重大影响。特别是由于眼部受累，称为特应性角膜结膜炎（AKC）。目前的治疗方法，比如dupilumab，常导致结膜炎,促使探索upadacitinib等替代疗法。方法：我们收集了6名中重度AD患者的皮肤病学和眼科前瞻性临床评估，由于治疗期间AKC的发作以及特别是头颈部皮炎的恶化，在停用dupilumab后接受upadacitinib治疗。临床评估,包括EASI分数,痒和睡眠NRS，DLQI,和眼部参数，在基线时(在转用upadacitinib前的筛查评估期间),然后在第12周和第24周进行.AKC的临床评估由一组眼科医生进行。结果：Upadacitinib不仅在EASI方面改善了特应性皮炎，瘙痒,和睡眠NRS，而且还显示出眼部体征和症状的显着减少，如视觉模拟量表(VAS)所示，Efron量表,和眼表疾病指数症状严重程度(OSDISS)评分。讨论：我们对常见临床实践的观察强调了生物和小分子疗法对AD的实质性影响，强调dupilumab相关性结膜炎的局限性。改用upadacitinib可显着改善临床和功能性眼部结局，提示其作为眼部受累AD患者的替代治疗选择的潜力。结论：所提供的数据提供了对AD中全身治疗和眼部表现之间复杂相互作用的见解。Upadacitinib成为解决dupilumab相关结膜炎的有希望的选择，改善患者的生活质量。
