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Background:

In the SARS-CoV-2/COVID-19 pandemic, we need to understand the impact of immunomodulatory medications on COVID-19 symptom severity in patients with inflammatory diseases, including the Type 2/Th2 polarized skin disease, atopic dermatitis/AD. Since it is believed that Type 1/Th1immunity controls viral infections, and that there is a Th1/Th2 counter-regulation, we hypothesized that Th2 targeting with the IL-4Rα-antagonist, dupilumab, in patients with moderate-to-severe AD rebalances Th1/Th2 axis, potentially leading to attenuated COVID-19 symptoms.

Methods:

: 1,237 moderate-to-severe AD patients in the Icahn School of Medicine at Mount Sinai Department of Dermatology were enrolled in a registry. Patients were screened for COVID-19-related symptoms and assigned a severity score (asymptomatic [0]-fatal [5]). Scores were compared among 3 treatment groups: dupilumab (n= 632), other systemic treatments (n= 107), and limited/no treatment (n= 498). Demographic and comorbid covariates were adjusted by multivariate logistic regression models.

Results:

: The dupilumab-treated group showed reduced incidence and severity of COVID-19 symptoms versus other treatment groups. Dupilumab-treated patients were less likely to experience moderate-to-severe symptoms versus patients on other systemics (p= 0.01) and on limited/no treatment (p= 0.04), and less likely to experience any symptoms versus patients on other systemics (p= 0.01). This effect was seen in our entire cohort and in the subgroup of patients with verified COVID-19 or high-risk exposure.

Conclusions:

: Patients on dupilumab experienced less severe …