COVID-19 Symptoms Are Attenuated in Moderate-to-Severe Atopic Dermatitis Patients Treated with Dupilumab

Abstract

What is already known about this topic? Preliminary data suggest increased type 2 cytokines during the COVID-19 cytokine storm. However, it remains unclear how COVID-19 outcomes differ between patients with atopic dermatitis (AD) on type 2etargeting agents (dupilumab) and those treated with other systemics or topical treatments.What does this article add to our knowledge? This is the first study to directly compare the severity of COVID-19 symptoms in patients with moderate-to-severe AD on different treatments, shedding important light on the treatment of patients with AD during the pandemic and beyond.How does this study impact current management guidelines? Our results suggest that type 2 targeting with dupilumab may attenuate COVID-19 responses, supporting the safety of specific type 2etargeting agents in patients with AD during the COVID-19 pandemic, and potentially extending to other viral infections.BACKGROUND: In the SARS-CoV-2/COVID-19 pandemic, we need to understand the impact of immunomodulatory medications on COVID-19 symptom severity in patients with inflammatory diseases, including the type 2/Th2 polarized skin disease, atopic dermatitis (AD). OBJECTIVE: Because it is believed that type 1/Th1 immunity controls viral infections and that there is a Th1/Th2 counterregulation, we hypothesized that Th2 targeting with the IL-4Ra-antagonist, dupilumab, in patients with moderate-to-severe AD would rebalance the Th1/Th2 axis, potentially leading to attenuated COVID-19 symptoms. METHODS: A total of 1237 patients with moderate-to-severe AD in the Icahn School of Medicine at Mount Sinai Department of Dermatology were enrolled in a registry. Patients were screened for COVID-19-related symptoms and assigned a severity score (asymptomatic [0]-fatal [5]). Scores were compared among 3 treatment groups: dupilumab (n [ 632), other systemic treatments (n [ 107), and limited/no treatment

Dupilumab use is associated with protection from COVID-19 mortality: A retrospective analysis

“…Through utilization of two databases, we have found that prior dupilumab usage in COVID-19 patients was associated with improved survival compared to matched controls. Previous work by Ungar et al, 2022 supported this finding, where, in atopic dermatitis patients dupilumab use was also associated with a reduction in severe outcomes from COVID-19 (Ungar et al 2022). We report these findings building off of in vivo work supporting a causal role for IL-13 in COVID-19 pathogenesis.…”

Dupilumab therapy in atopic dermatitis is safe during COVID‐19 infection era: A systematic review and meta‐analysis of 1611 patients

“… 8 Furthermore, the elevation of Th2 cytokines in serum of COVID‐19 patients was reported repeatedly specially during the cytokine storm. 9 …”

“…Hence the latter two interleukins have crucial role in the pathogenesis of AD 10 ; in this context dupilumab was the first FDA approved immunomodulatory medication to treat moderate to severe AD. 1 , 9 , 10 …”

Safety and Efficacy of Dupilumab for the Treatment of Hospitalized Patients with Moderate to Severe COVID 19: A Phase IIa Trial

“…Dupilumab has since been shown to reduce symptom severity and improve clinical outcomes in other observational studies utilizing large patient databases 17,18 .…”

“…Patients on dupilumab had a 12.3% absolute risk reduction in mortality compared to a propensity score matched sub cohort of 81 patients with COVID-19 not on dupilumab but with atopic diseases for which dupilumab is routinely used 9 . Dupilumab has since been shown to reduce symptom severity and improve clinical outcomes in other observational studies utilizing large patient databases 17,18 .…”