Lebrikizumab Induced Ocular Surface Disease: A Prospective Case Series

Lebrikizumab is a monoclonal antibody that binds selectively to IL-13, a key mediator in atopic dermatitis (AD) pathogenesis and has recently been approved for use in treatment of moderate-to-severe AD. We aim to identify the incidence, risk factors, demographics, and clinical profile of lebrikizumab-induced ocular surface disease (LIOSD) in adult patients with AD and describe the treatment outcomes.

A tertiary teaching hospital in the UK where patients with moderate AD were undergoing novel treatment with lebrikizumab.

A prospective case series was carried out on AD patients treated in Barts Health NHS Trust, UK, who developed ocular symptoms after commencing Lebrikizumab between December 2023 and December 2024. Demographics, AD severity scores, blood IgE levels, previous atopic keratoconjunctivitis (AKC), dermatological response to lebrikizumab, ophthalmological evaluation, and treatment were noted. Univariate and multivariate analyses were used to identify risk factors for LIOSD.

10 of 18 included patients (55.56%) developed LIOSD. Median age was 43 years (range 19-74). Male to female ratio was 1:1. Average time to onset of ocular symptoms from starting lebrikizumab was 6.2 weeks (range 3-40). The presence of severe AD and eyelid or facial eczema were the strongest predictors of LIOSD. 90% of patients had bilateral conjunctival inflammation and blepharitis at presentation. No patients required lebrikizumab discontinuation.

LIOSD is very common in AD patients receiving lebrikizumab. The initial observation suggests a higher prevalence and more rapid onset of ocular surface disease compared to other monoclonal antibodies such as dupilumab and tralokinumab. While most cases are mild, some patients can develop blepharoconjunctivitis which responds well to topical treatment. AD severity, and eyelid or facial eczema are risk factors for LIOSD.