Dupilumab, Eczema Immunomodulatory Therapies May Not Increase Risk of Severe COVID-19

Annelle Musters, MD

Patients with atopic dermatitis may not face an increased risk of COVID-19 complications—even if infected while on systemic immunomodulatory therapy.

In new late-breaking session data presented at the American Academy of Dermatology (AAD) 2022 Annual Meeting in Boston this weekend, an international team of investigators found patients taking biologic and other potentially immunocompromising therapies for their atopic dermatitis were associated with low risk of severe COVID-19.

In fact, patients on dupilumab monotherapy were linked to ever lessened odds of hospitalization due to COVID-19 than patients on other atopic dermatitis drugs.

Presented by Annelle Musters, MD, PhD candidate, of the Amsterdam University Medical Centers, the Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE-AD) registry steering group sought to understand whether systematic immunomodulatory therapies, as well as novel systemic therapies, particular influence the outcome of COVID-19 in patients with atopic dermatitis.

In fact, as they noted, immune pathway-targeting biologics may actually help reduce the development of significant inflammation observed in severe COVID-19. Specifically, dupilumab’s role as an interleukin 4 and 13 (IL-4, IL-13) inhibitor may have a “protective effect in the context of COVID-19 infection.”

The SECURE-AD registry was established to investigate the impact of COVID-19 on both treated and untreated patients with atopic dermatitis. Musters and colleagues assessed 452 registry patients from 27 countries, infected with COVID-19 between April 2, 2020 and October 31, 2021.

Mean patient age was 35.9 years old. Their median body mass index was 23.7; 52% were male, and patients were most significantly White and resided in Italy. About two-thirds (69%) were diagnosed by COVID-19 through a positive test; the remaining were “highly suspected” to have the disease in the early stages of the pandemic.

More than 120 patients received lone topical therapy for their atopic dermatitis. Nearly 220 patients received dupilumab. The next most common therapies included methotrexate, other conventional systemic therapies, and combination systemic treatments.

Among the registry patients, 12.4% were admitted to an emergency department while sick with COVID-19; 9.5% were hospitalized, 1.8% were admitted to the intensive care unit (ICU), and 1.4% required ventilation. No patients observed in the assessment had died from COVID-19.

Musters and colleagues observed that 9.9% (n = 13) of patients with atopic dermatitis receiving lone topical therapy were hospitalized with COVID-19, versus just 2.3% (n = 5) of patients receiving dupilumab (OR, 4.65; 95% CI, 1.62 – 13.36).

When adjusting for confounding variables, investigators observed a still significantly greater risk of COVID-19 hospitalization among patients receiving topical treatment (OR, 4.95; 95% CI, 1.31 – 18.67) than dupilumab. Odds were additionally worse for patients with atopic dermatitis receiving systemic corticosteroids (OR, 2.81; 95% CI, 0.15 – 52.42) or other conventional systemic treatments (OR, 2.36; 95% CI, 0.22 – 24.77).

The greatest hospitalization rates were observed among patients treated with combination systemic therapy including systemic corticosteroids, though this only comprised of 4 total patients (50%).

Nonetheless, investigators concluded that non-steroidal immunosuppressive monotherapy was associated with lowered odds of COVID-19 hospitalization for patients with atopic dermatitis when compared to combination systemic therapy.

“Other population-based study designs are more suitable to answer other important questions—for example, if the overall risk of COVID-19 in (atopic dermatitis) patients is higher or lower compared to healthy controls,” they concluded.

The study, “Outcomes After COVID-19 Infection in Patients with Atopic Dermatitis,” was presented at AAD 2022.