Andogsky syndrome: experience with anti-IL-4, 13 therapy

BACKGROUND: Dupilumab, a monoclonal antibody targeting the alpha subunit of the interleukins 4 and 13 receptor, has fundamentally transformed the approach to treating atopic conditions such as atopic dermatitis, bronchial asthma, and chronic rhinosinusitis. However, its increasing use has drawn heightened attention to several adverse ocular events — conjunctivitis, blepharitis, keratitis, corneal ulcers, and cicatricle conjunctivitis — that remain underrecognized and often underestimated in clinical practice. These manifestations frequently occur in patients with atopic dermatitis and vary in severity, posing diagnostic and therapeutic challenges.

AIM: To study the efficacy and safety of anti-IL-4,13 therapy in Andogsky syndrome.

MATERIALS AND METHODS: The study included patients with moderate-to-severe atopic dermatitis and cataracts who had experienced insufficient efficacy from conventional treatment over a period of at least 3 months. The decision to prescribe dupilumab was made by a medical commission based on the assessment of the SCORAD index and the previous volume of therapy. Patients were monitored dynamically for 16 weeks. Follow-up visits were conducted at weeks 4 and 16. During these visits, an assessment of atopic dermatitis symptom control was performed using the SCORAD, DQLI, and POEM scales. Additionally, monitoring of adverse events and their timing was conducted.

RESULTS: The study included 5 patients with Andogsky syndrome. Four of them had a history of surgical treatment for cataracts, and initiation of anti-IL-4,13 therapy for severe atopic dermatitis was performed more than 5 years after cataract surgery. One patient with severe atopic dermatitis and progressive cataracts started therapy prior to surgical intervention. The initiation of systemic therapy allowed for successful cataract treatment and preservation of visual acuity without development of adverse events related to dupilumab. No adverse events, including those related to the visual organs, were recorded in this cohort of patients during the entire observation period (52 weeks).

CONCLUSION: The therapeutic potential of dupilumab in the treatment of Andogsky syndrome is of particular interest, given the complex nature of the disease and the involvement of various body systems. Suppression of T2 inflammation through inhibition of interleukins 4 and 13 leads to a reduction in the severity of skin manifestations, a decrease in the intensity of the inflammatory process, and improvement in ophthalmological parameters. Further study of the efficacy of dupilumab in Andogsky syndrome will allow: to determine the optimal duration of therapy, evaluate the impact on disease progression and develop personalized treatment approaches.