Is It Necessary to Discontinue Dupilumab in Patients with Atopic Dermatitis During the COVID-19 Pandemic?
Italian authors described their experiences with remote treatment of 200 atopic dermatitis (AD) patients using dupilumab during the COVID-19 pandemic outbreak in spring 2020. Observations from clinical practice, published data, and pathophysiological considerations do not suggest an increased risk of SARS-CoV-2 infection in AD patients receiving this biological treatment.
Findings on the Safety of Biologic Treatment During the COVID-19 Pandemic
Despite concerns about increased risks associated with COVID-19 in patients on biologic treatment, published studies to date show the safety of this therapy. There is no evidence that dupilumab, a human monoclonal antibody against interleukins 4 and 13 indicated for the treatment of atopic dermatitis, increases the risk of SARS-CoV-2 infection. One study even describes the safety of this therapy in 2 patients with COVID-19 infection.
More detailed data are provided by a survey conducted among adult Italian AD patients treated with dupilumab, who underwent telephone consultations instead of in-person visits to dermatology offices from March 11 to April 12, 2020.
Results of the Italian Survey
Of the 200 patients, 102 were women, and the average age was 44 ± 19 years. None of the patients reported symptoms of COVID-19 infection confirmed by nasopharyngeal swab or serological tests. Only 2 patients (1%) underwent a COVID-19 test due to contact with a person with confirmed infection, and their nasopharyngeal swab was negative. 3 patients (1.5%) reported having elevated temperature or cough in the past month (average duration of symptoms 3.2 days, maximum body temperature 37.0 °C), which spontaneously resolved without the development of shortness of breath.
Regular dupilumab treatment was received by 193 (96.5%) of the enrolled patients, while 5 (2.5%) had to extend the interval between administrations to 3 weeks due to drug unavailability. None of the patients experienced worsening of AD symptoms.
From the observations described among Italian patients, it appears that the use of dupilumab does not pose an increased risk for patients in terms of COVID-19 infection.
Interleukins in the Pathogenesis of COVID-19
The pathogenesis of COVID-19 involves an immune response primarily mediated by TH1 and TH17 lymphocytes. Their hyperactivation induces the release of pro-inflammatory cytokines, which can lead to lung damage. Interleukins 4 and 13 are products of TH2 lymphocytes and do not participate in the body's defense against viral infections. Neither viral nor respiratory infections were reported as significant adverse events in clinical studies with dupilumab.
Conclusion
Discontinuing biologic treatment in AD patients could lead to a loss of efficacy due to the development of antibodies against the drug and, most notably, increase the overall burden of the disease. Based on current findings, it is not advisable to discontinue dupilumab treatment for atopic dermatitis due to the ongoing COVID-19 pandemic.
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Source: Napolitano M., Patruno C., Ruggiero A. et al. Safety of dupilumab in atopic patients during COVID-19 outbreak. J Dermatolog Treat 2020 Jun 19: 1−2, doi: 10.1080/09546634.2020.1771257 [Epub ahead of print].
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