medwireNews: Children with early-onset atopic dermatitis may be at increased risk for uveitis, irrespective of whether they have autoimmune conditions or are receiving dupilumab, report researchers.
They found that the risk for uveitis was increased by a significant 92% among 114,889 children who developed atopic dermatitis before the age of 2 years, when compared with the same number of children without atopic dermatitis.
“These findings support the potential need to consider ophthalmologic monitoring in children with early-onset [atopic dermatitis] to try to detect and subsequently manage uveitis if it develops,” write Shu-Chun Kuo (Chi-Mei Medical Center, Tainan City, Taiwan) and co-authors in JAMA Ophthalmology.
For the study, data on a total of 129,486 children with atopic dermatitis based on ICD-10 codes who had at least one related follow-up visit and received treatment within a year, and 324,860 children without atopic dermatitis were sourced from healthcare organizations in the collaborative research network TriNetX. The two groups were reduced to 114,889 children each after propensity score matching for mean follow-up (6.0 and 6.6 years, respectively), age (0.5 and 0.6 years), and sex (56.4% and 56.9% boys).
In all, 94 (0.08%) of the children with atopic dermatitis developed uveitis, compared with 58 (0.05%) of those without. The increased risk for uveitis was even greater for the 3004 children who had severe atopic dermatitis, with a significant hazard ratio of 3.64 compared with the 126,482 children with nonsevere atopic dermatitis, and rates of 0.40% versus 0.08%.
Patients were considered to have severe atopic dermatitis if, within a year of their first symptoms, they had received: at least one treatment with omalizumab, dupilumab, tralokinumab, abrocitinib, baricitinib, upadacitinib, intravenous immunoglobulin, interferon gamma, or rituximab; and/or cyclosporine, azathioprine, mycophenolate mofetil, methotrexate, or systemic corticosteroids for more than 2 weeks.
Sensitivity analyses also showed that the increased risk for uveitis among people with atopic dermatitis was independent of dupilumab use, to which previous studies have attributed an increased risk, as well as autoimmune conditions, with significant hazard ratios relative to those without atopic dermatitis of 1.77 and 1.52, respectively, and rates of 0.08% versus 0.05%, and 0.07% versus 0.05%.
The investigators acknowledge that the study’s reliance on ICD-10 codes, its retrospective nature, and the fact that it was not population based are limitations and they recognize the need for larger studies to clarify the proposed risk for uveitis in these patients.
Nevertheless, they say that, given the “sequelae of uveitis can be severe, with some patients developing bilateral cataracts or even amblyopia, their findings “support an interdisciplinary approach, involving dermatology, ophthalmology, immunology, and pediatrics, that might contribute to optimized care for both [atopic dermatitis] and its associated ocular complications.”
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