Management of patients with atopic dermatitis undergoing systemic therapy during COVID‐19 pandemic in Italy: Data from the DA‐COVID‐19 registry

Abstract

Background Few and small studies have described the management of immunomodulant/immunosuppressive therapies or phototherapy in atopic dermatitis (AD) patients during coronavirus disease 2019 (COVID‐19) pandemic. Methods A national registry, named DA‐COVID‐19 and involving 35 Italian dermatology units, was established in order to evaluate the impact of COVID‐19 pandemic on the management of adult AD patients treated with systemic immunomodulant/immunosuppressive medications or phototherapy. Demographic and clinical data were obtained at different timepoints by teledermatology during COVID‐19 pandemic, when regular visits were not allowed due to sanitary restrictions. Disease severity was assessed by both physician‐ and patient‐reported assessment scores evaluating itch intensity, sleep disturbances, and AD severity. Results A total of 1831 patients were included, with 1580/1831 (86.3%) continuing therapy during pandemic. Most patients were treated with dupilumab (86.1%, 1576/1831) that was interrupted in only 9.9% (156/1576) of cases, while systemic immunosuppressive compounds were more frequently withdrawn. Treatment interruption was due to decision of the patient, general practitioner, or dermatologist in 39.9% (114/286), 5.6% (16/286), and 30.1% (86/286) of cases, respectively. Fear of increased susceptibility to SARS‐CoV‐2 infection (24.8%, 71/286) was one of the main causes of interruption. Sixteen patients (0.9%) resulted positive to SARS‐CoV‐2 infection; 3 of them (0.2%) were hospitalized but no cases of COVID‐related death occurred. Conclusions Most AD patients continued systemic treatments during COVID pandemic and lockdown period, without high impact on disease control, particularly dupilumab‐treated patients.

COVID-19 in Patients with Atopic Dermatitis Treated with Dupilumab: Three Cases and a Literature Review

“…None of the patients reported any worsening in skin symptoms. Chiricozzi et al 5 reported that 9.9% of patients in their group stopped dupilumab at least temporarily, while in Georgakopoulos and Yeung’s 17 cohort of patients treated with dupilumab for AD, only 0.62% temporarily stopped treatment. These differences could be related to the point in time of the COVID-19 pandemic, as in due course more knowledge about the infection was gained and patients felt more reassured to continue with their treatment.…”

“… 3–5 Teledermatology services have developed very quickly in a majority of dermatology departments, with good effectiveness and high satisfaction scores from the patients. 5–7 With more data available, recommendations and guidelines have been published to help advise dermatological patients regarding their treatments. 3–5 , 8 , 9 …”

“…Until recently, only isolated clinical case reports of patients with AD treated with dupilumab at the time of COVID-19 infection were available, with clinical details presented in Table 2 . 10−14 A large group of AD patients on systemic treatments was monitored by Chiricozzi et al 5 during the first wave of COVID-19 in Italy in 2020. Interestingly, a majority of those patients were treated with dupilumab in mono- or combined therapy.…”

“…Due to the strict lockdown measures, data on precise skin condition of presenting patients around the time of COVID-19 based on SCORAD and EASI were not possible to include in featured reports. 5 ,10−14 In our patients, all scores were available, including at the time before dupilumab was started, after 1 month, and within 2 weeks of COVID-19 diagnosis. Only in one of three patients was a significant deterioration in SCORAD, EASI, and DLQI observed on the day of infection diagnosis, with all parameters having improved 1 month later.…”

“…Due to the worldwide SARS-CoV2 pandemic declared by the World Health Organization in March 2020, many problems arose in dermatological therapy, not only with COVID-19–positive patients’ treatment at the time of the infection but also with maintenance of their chronic diseases, 3–5 specifically concerns related to immunosuppressants and immunomodulatory medications and their possible impact on the COVID-19 course in treated patients, as well as consequences of stopping the treatment in patients with poorly controlled skin conditions. 3 , 5 In March 2020, the European Task Force on Atopic Dermatitis published a statement on SARS-CoV2 infection and AD that medications interfering mainly with type 2 inflammation, eg, dupilumab, that do not seem to increase the rate of viral infections may be preferable to treatments with immunosuppressants during the COVID-19 pandemic. 3 The authors hoped that more clinical data would help to assess the risk:benefit ratio for these patients.…”