Data Suggests Lower COVID-19 Incidence in Dupilumab-Treated AD Patients

Asfandyar Mufti, MD

New data suggested the the incidence of COVID-19 infection may be lower among patients with atopic dermatitis (AD), asthma, and/or nasal polyps who are undergoing dupilumab treatment compared to the general population of Canada.

The new findings, presented at the American Academy of Dermatology (AAD) 2022 Annual Meeting in Boston, MA, support the recommendations that individuals with atopic diseases should not discontinue or delay dupilumab treatment due to fears of contracting the COVID-19 virus.

Even now, researchers remain uncertain of the effects of immune-modulating therapies in the clinical course of COVID-19, leading to heightened concerns of an increased risk of infection in patients with atopic diseases receiving dupilumab.

However, several international societies have recommended continuing dupilumab treatment in individuals who have not tested positive for the virus.

As such, investigators led by Asfandyar Mufti, MD, Division of Dermatology at the University of Toronto investigated the incidence of prognostic outcomes of COVID-19 infection in patients with atopic diseases who were treated with dupilumab.

A total of 5 tertiary academic centers and 7 community practices across Canada participated in the multi-center retrospective cohort study.

Patients with AD, asthma, and/or nasal polyps treatred with dupilumab were eligible for inclusion, and data for COVID-19 infections were collected from Patient Support Program case managers and patient-reported clinical documentation.

A total of 548 patients on dupilumab met the criteria. Among then, only 2 patients (0.36%) had laboratory confirmed cases of COVID-19.

Both patients – 1 male and 1 female- were treated with dupilumab for less than 6 months, with 1 patient being an asymptomatic cattier and the other having several symptoms including cough, dyspnea, and fever.

Though both patient temporarily discontinued dupilumab treatment, both resumed treatment with a mean restart time of 14 days.

Mufti and colleagues believed the data suggested that the incidence of COVID-19 infection was lower among patients with AD, asthma, and/or nasal polyps on dupilumab.

Additionally, the team referenced a previous Italian-based registry study that included 1576 patients, 15 of whom had AD and a COVID-19 infection and were treated with dupilumab.

In that study, 3 of those patients were subsequently hospitalized , but no COVID-19-related deaths occurred.

Regarding the present study, the team cited several limitations including short-term follow-ups, asymptomatic cases without proper lab tests, and patients who chose not to disclose their positive test results, among other reasons.

“Despite these limitations, the results suggest that treatment with dupilumab does not increase the risk of SARS-CoV-2 infection or worsen its signs and/or symptoms in patients with AD, asthma, and/or nasal polyps,” the team wrote.