Dupilumab, Immunomodulatory Drugs for Atopic Dermatitis Not Found to Increase Risk of Severe COVID-19

Treatment with dupilumab (Dupixent) among patients with atopic dermatitis was not linked to a greater risk of complications from COVID-19, according to late-breaking session data presented at the American Academy of Dermatology 2022 Annual Meeting. Further, patients administered dupilumab monotherapy were found to have lower odds of hospitalization from COVID-19 than were individuals on other atopic dermatitis drugs.

The international team of investigators found that the use of biologics and other potentially immunocompromising therapies for atopic dermatitis was associated with low risk of severe COVID-19.

The study, “Outcomes After COVID-19 Infection in Patients with Atopic Dermatitis,” sought to evaluate whether systematic immunomodulatory therapies and novel systemic therapies affected the outcomes from COVID-19 in patients with atopic dermatitis.

The study authors noted that immune pathway-targeting biologics may actually help lower the development of significant inflammation found in severe COVID-19. Notably, they said dupilumab’s role as an interleukin 4 and 13 (IL-4, IL-13) inhibitor may confer a “protective effect in the context of COVID-19 infection.”

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

Among these patients, the mean age was 35.9 years, median body mass index was 23.7, 52% were male, and patients were most frequently White and resided in Italy. Approximately two-thirds (69%) were diagnosed with COVID-19 via a positive test, whereas the remaining patients were highly suspected to have the virus during the early stages of the pandemic.

More than 120 patients were administered a lone topical therapy for atopic dermatitis and approximately 220 patients were administered dupilumab. The next most commonly used therapies were 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, and 1.4% required ventilation. No patients observed in the assessment died from COVID-19.

The investigators found that 9.9% (n = 13) of patients with atopic dermatitis administered a lone topical therapy were hospitalized with COVID-19 compared with 2.3% (n = 5) of patients administered dupilumab (OR, 4.65; 95% CI, 1.62 – 13.36).

When adjusting for confounding variables, there was a still significantly greater risk of COVID-19 hospitalization found among those administered topical treatment (OR, 4.95; 95% CI, 1.31 – 18.67) than for dupilumab. These odds were worse for patients with atopic dermatitis who were administered 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 seen among individuals administered combination systemic therapy, such as systemic corticosteroids; however, this only included 4 total patients (50%). The investigators concluded that non-steroidal immunosuppressive monotherapy was associated with reduced odds of COVID-19 hospitalization for patients with atopic dermatitis versus combination systemic therapy.