Dupilumab for atopic dermatitis linked to lower antibody levels after COVID-19 infection
Patients taking dupilumab for atopic dermatitis who developed COVID-19 had lower levels of antibodies and milder symptoms than patients on other treatments, according to a study published in Annals of Allergy, Asthma & Immunology.
Also, dupilumab (Dupixent, Regeneron/Sanofi) did not appear to impair antibody responses to mRNA vaccination, results showed.
“This study was prompted by two factors at the start of the pandemic in March 2020,” Benjamin Ungar, MD, of the department of dermatology and laboratory of inflammatory skin diseases at the Icahn School of Medicine at Mount Sinai, told Healio.
“We wanted to better understand the impact of atopic dermatitis and its treatments, which are typically immunomodulatory, on COVID-19 risks and outcomes so that treatment decisions could be informed by good evidence,” Ungar said.
Also, Ungar said, Emma Guttman-Yassky, MD, PhD, Waldman Professor and System Chair of the Kimberly and Eric J. Waldman Department of Dermatology at the Icahn School of Medicine at Mount Sinai, had observed that many of her patients on dupilumab seemed to have relatively mild COVID-19 symptoms, or were even asymptomatic, despite family members and other close contacts who became very sick.
The researchers aimed to evaluate IgG antibody levels in patients on various treatments for AD aged 12 years and older who had been infected with SARS-CoV-2 prior to mRNA vaccination, as well as among vaccinated patients.
Between June 8, 2020, and Oct. 14, 2021, the researchers collected 54 serum samples from COVID-19-infected patients before vaccination — including 23 patients receiving dupilumab for at least 2 months, eight receiving systemics and 23 on limited treatment — and 180 samples from patients at least 14 days after mRNA vaccination, including 101 receiving dupilumab, 15 on systemics and 64 receiving limited treatment.
The 54 patients in the prevaccination cohort showed decreased symptom severity associated with lower levels of IgG antibodies across all treatments. These results are consistent with previous studies associating more severe COVID-19 with greater SARS-CoV-2 antibody levels, the researchers wrote.
Also, patients who were asymptomatic or who had mild COVID-19 symptoms had lower antibody titers than patients who had moderate symptoms (mean ± standard error, 52.5 ± 20.3 vs. 96.2 ± 36.1; P = .03).
The patients on dupilumab had significantly lower levels of antibodies than patients treated with systemics (age-adjusted quantitative antibody levels, 29 ± 35.7 vs. 170.5 ± 54.9; P = .01) and a trend toward lower levels compared with patients receiving limited treatment.
The postvaccination assessment also found similar rate decreases in antibody levels over time between the treatment cohorts, with no differences in antibody levels. According to the researchers, this indicates that dupilumab reduces COVID-19 symptom severity and downstream IgG levels without impairing antibody responses.
Overall, the researchers said patients should continue dupilumab treatment regardless of their vaccination status.
“The results of this study are significant, because they provide evidence and support that treatment of atopic dermatitis with dupilumab, a very common treatment, is safe in the context of the COVID-19 pandemic,” Ungar said.
“Many patients are understandably concerned that immune-modifying treatments may make them more vulnerable but, in fact, this study shows that dupilumab may even reduce symptom severity,” he continued.
Ungar also said that doctors and patients have many considerations when they are determining their treatment plan and that understanding the effects of treatment during the pandemic is at the forefront of many people’s minds.
“Doctors can use these findings to allay COVID-19-related concerns when treating [patients with atopic dermatitis] with dupilumab,” he said.
Next, Ungar said, the researchers will continue to study the impact of AD and its treatment on different aspects of the immune system with COVID-19 vaccination.
For more information:
Benjamin Ungar, MD, can be reached at email@example.com.