Attenuated COVID 19 symptoms in dupilumab-treated atopic dermatitis patients
Published: November 01, 2021
In the ongoing pandemic, understanding how chronic diseases and their treatments modify the risk with COVID 19 infection is crucial. Inflammatory diseases that are characterized by abnormal immune states are of interest, because not only might the underlying immune abnormalities impair normal anti-viral responses, but immune-modifying treatments for those may also affect responses to viral infection. Atopic dermatitis (AD) is one such very common disease, with elevated baseline type 2/Th2 inflammation; increased Th2 inflammation has been hypothesized to blunt the type 1/Th1 immune activation that is primarily responsible for beneficial anti-viral responses. Furthermore, many moderate-to-severe AD patients are treated with systemic therapies that act broadly to reduce inflammation (e.g., systemic steroids, JAK inhibitors) or more specifically to inhibit Th2 signaling (dupilumab). Thus, the impact of Th2 blockade with dupilumab vs. broad immunosuppression vs. untreated AD on COVID 19 outcomes is relevant to a large population of patents.
In order to understand better the interactions of AD and its treatments with COVID 19 infection, Ungar et al. performed a large registry study that prospectively tracked moderate-to-severe AD patients in the Department of Dermatology at the Icahn School of Medicine in New York City. Over 1,200 AD patients ages 9 and up were enrolled in the study beginning in April 2020 and¬ assigned a COVID 19 severity score (asymptomatic, mild, moderate, severe, very severe, fatal) based on the presence and duration of COVID 19-related symptoms. The authors then compared COVID 19 severity among 3 groups: dupilumab-treated patients, patients on other systemic treatments, and AD patients either untreated or on topical treatments alone. They included all participants in the registry, regardless of formal COVID 19, diagnosis, because of the lack of testing available in the early months of the pandemic. They also performed a further subgroup analysis focusing on confirmed COVID 19 cases or subjects with known high-risk exposures was also performed. Ungar et al. published the results of this study in The Journal of Allergy and Clinical Immunology: In Practice.
Overall, Ungar et al. found that dupilumab treatment for AD patients reduced COVID 19 symptom severity. After adjusting for demographic factors such as age, gender, and race, as well as comorbidities such as obesity, hypertension, and diabetes, they found that dupilumab-treated patients were almost 4 times less likely to have moderate-to-severe COVID 19 symptoms compared to those on other systemic treatments, and almost 2 times less likely than untreated or topically treated patients. Dupilumab-treated patients were also almost 2 times more likely to be asymptomatic than patients on other systemic treatments. When focusing on the subgroup of patients with confirmed COVID 19 infection or those with high-risk exposures, similar results were observed, with even greater effect sizes. After adjusting for similar demographic factors and comorbidities, dupilumab-treated patients were more than 13 times less likely to experience moderate-to-severe COVID 19 symptoms than those on other systemic treatments and almost 2.5 times less likely than untreated or topically treated patients. Similarly, they were almost 3 times more likely to be symptomatic than patients on other systemic treatments.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.