Authors
Jarmila Čelakovská, Eva Čermáková, Petra Boudkova, Ctirad Andrýs
Published in
Frontiers in immunology. Volume 17. Pages 1873001. Epub Aug 06, 2026.
Abstract
Dupilumab is an effective treatment for moderate-to-severe atopic dermatitis (AD), yet a substantial proportion of patients develop ocular complications collectively termed dupilumab-associated ocular surface disease (DAOSD). Despite multiple proposed mechanisms - including goblet cell depletion, mucin deficiency, Th1/Th17 immune shifts, and microbiome alterations - no upstream epithelial cytokine marker has been clearly identified.
To evaluate whether plasma cytokines differ between AD patients treated with dupilumab who develop ocular complications and those without ocular involvement.
Complex dermatological examination was performed in adult AD patients receiving dupilumab for ≥24 months. Plasma cytokines (IFN-γ, TNF-α, IL-23, IL-2, IL-31, IL-6, IL-17A, IL-17E, IL-12p70, TSLP, IL-4, IL-5, IL-13, IL-10, IL-33) were quantified under unstimulated and PMA/ionomycin-stimulated conditions in winter and summer seasons. Differences between groups were assessed using non-parametric tests (Mann-Whitney U test and Kolmogorov-Smirnov test). To account for multiple comparisons across the large number of tested cytokines, false discovery rate (FDR) correction was performed using the Benjamini-Hochberg procedure with a significance threshold of q = 0.05. Receiver operating characteristic (ROC) analysis was performed to evaluate biomarker potential to explore potential discriminative performance. AUC values were calculated using empirical (non-parametric) ROC analysis.
During the summer period, stimulated thymic stromal lymphopoietin (TSLP) levels were nominally higher in patients with ocular complications compared with those without (p = 0.045). However, this difference did not remain statistically significant after FDR correction. In winter, stimulated TSLP showed a non-significant trend toward higher levels (p = 0.088). No other cytokines differed between groups. ROC analysis demonstrated moderate discriminative ability of stimulated TSLP (AUC 0.81 in summer; 0.70 in winter), although confidence intervals were wide.
Stimulated TSLP may represent a preliminary observation requiring confirmation in dupilumab-treated AD patients with ocular complications.
PMID:
42625606
Bibliographic data and abstract were imported from PubMed on 21 Aug 2026.
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