How does COVID-19 impact atopic dermatitis patients in dupilumab therapy? An investigative online survey

Grieco, Teresa; Chello, Camilla; Sernicola, Alvise; Muharremi, Rovena; Michelini, Simone; Paolino, Giovanni; Carnicelli, Giorgia; Pigatto, Paolo Daniele

Data on the tolerability and response to biologic therapies for type 2 immune disorders in the context of COVID-19 is currently lacking. Our survey aimed at assessing the adherence of patients to dupilumab therapy and the risk of SARS-CoV-2 infection. 80 subjects with atopic dermatitis treated with dupilumab completed a web-based survey. Seven subjects discontinued dupilumab due to concerns and difficulties related to COVID-19. Our sample was highly susceptible to viral infection due to the frequency of risk factors including living in high SARS-CoV-2 burden areas – such as Northern Italy –, comorbidities – asthma, diabetes and cardiovascular disease – and advanced age. Elderly subjects in our sample are particularly exposed to the risk of COVID-19-related cytokine storm, triggered by excessive IL-4 production and type 2 immune response. One patient contracted SARS-CoV-2 infection without progression of COVID-19 despite continuing scheduled dupilumab treatment. Because evidence on the appropriate management of biologic therapy in the setting of COVID-19 is lacking, the collection of clinical data from patients in treatment with dupilumab is a valuable addition to current clinical practice. Our survey provides a contribution to the understanding of the tolerability and response to dupilumab during COVID-19 and suggests a feasible and effective approach to patients in treatment with biologics even when social distancing is required.