Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis

Two Phase 3 Trials of Dupilumab versus Placebo in Atopic DermatitisTo the Editor: The conclusions of Simpson and colleagues (Dec.15 issue) 1 regarding the effectiveness and quality-of-life-enhancing capacity of dupilumab in patients with atopic dermatitis open new perspectives in the strategies of treatment of allergic diseases, because interleukin-4 and interleukin-13 are "type 2 inflammatory cytokines that may be important drivers of atopic or allergic diseases."Given the good results in patients with asthma 2 or nasal polyposis, 3 we as pediatricians look with interest to the possibilities arising from these studies involving adults.However, the higher rate of allergic conjunctivitis in the dupilumab-treated population than in the placebo group in this trial runs against these wishes.Although we agree with the authors that "further studies on the causes of conjunctivitis are warranted," could these be cases of atopic keratoconjunctivitis rather than simple allergic conjunctivitis?This condition is often linked to atopic dermatitis. 4If so, could it be hypothesized that the blockage of interleukin-4 and interleukin-13 increases the activity of the specific ligands involved in atopic keratoconjunctivitis (e.g., the OX40 ligand) in the eye, an immunologically privileged area? 5 This would limit the potential uses of dupilumab in the allergy field.