"Based on this large study of over 1,200 atopic dermatitis (AD) patients, clinicians can feel confident that dupilumab does not increase risk for more severe COVID-19 symptoms and even appears to be protective," Dr. Benjamin Ungar of the Icahn School of Medicine at Mount Sinai in New York City told Reuters Health by email.
Dr. Ungar and his colleagues analyzed data from patients with moderate to severe AD in the registry of one academic dermatology treatment center. The patients had been screened for COVID-19-related symptoms and assigned a severity score between 0 (asymptomatic) and 5 (fatal).
As reported in The Journal of Allergy and Clinical Immunology: In Practice, the team compared scores in three treatment groups: 632 patients treated with dupilumab, 107 receiving other systemic treatments, and 498 receiving limited or no treatment.
Adjusting for demographic variables and comorbidities, the dupilumab group showed the lowest incidence and severity of COVID-19 symptoms. Dupilumab-treated patients were less likely to have moderate-to-severe symptoms than were patients on other systemics (odds ratio, 3.89; P=0.008) or those on limited or no treatment (OR, 1.96; P=0.04).
Patients in the dupilumab group were also significantly less likely to have any symptoms than were patients on other systemics. This relationship held in the entire cohort and in the subgroup of patients with verified COVID-19 or high-risk exposure.
The study is "the first to demonstrate the significant protection potentially offered by Th2 targeting with dupilumab in reducing symptom incidence and severity compared with other treatments for AD in the context of COVID-19 infection," the authors write. "These findings have important implications, not only for the millions of patients with moderate-to-severe AD in this country exposed to COVID-19 and other viral infections, but potentially for patients with chronic atopic and other conditions on immunomodulatory medications."
"This is an important study for clinical practice and patient care in this era as dupilumab showed a trend of attenuated COVID-19 symptoms," senior author Dr. Emma Guttman-Yassky, also of the Icahn School of Medicine at Mount Sinai, said by email. "Use of a type-2 immune-targeted treatment such as dupilumab may in fact be beneficial beyond the skin diseases."
The authors caution that the study's registry-based design can introduce sampling and recall bias. Also, for many patients, confirmation of COVID-19 infection by serology testing was not available.
"Further research will be needed to evaluate whether dupilumab may also help reduce symptom severity for other viral illnesses, with implications extending beyond the current pandemic," Dr. Ungar said.
Regeneron and Sanofi, which market dupilumab, partially funded the study and reviewed and accepted the manuscript before submission. Dr. Guttman-Yassky and two of her coauthors report financial ties to the drugmakers.
SOURCE: https://bit.ly/3Flktas The Journal of Allergy and Clinical Immunology: In Practice, online November 1, 2021.
By Lorraine L. Janeczko
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