The effects of systemic immunomodulatory treatments on COVID‐19 outcomes in patients with atopic dermatitis: results from the global SECURE‐AD registry

A H Musters; C Broderick; D Prieto‐Merino; A Chiricozzi; G Damiani; K Peris; S Dhar; A De; E Freeman; B W M Arents; T Burton; A L Bosma; C‐C Chi; G Fletcher; A M Drucker; K Kabashima; E F de Monchy; M Panda; D Wall; C Vestergaard; E Mahé; L Bonzano; L Kattach; M Napolitano; M F Ordoñez‐Rubiano; E Haufe; C Patruno; A D Irvine; P I Spuls; C Flohr

doi:10.1111/jdv.18613

. 2022 Sep 28:10.1111/jdv.18613. Online ahead of print. doi: 10.1111/jdv.18613

The effects of systemic immunomodulatory treatments on COVID‐19 outcomes in patients with atopic dermatitis: results from the global SECURE‐AD registry

A H Musters ^1,^#, C Broderick ^2,^#, D Prieto‐Merino ³, A Chiricozzi ^4,⁵, G Damiani ^6,^7,⁸, K Peris ^9,¹⁰, S Dhar ¹¹, A De ¹², E Freeman ^13,¹⁴, B W M Arents ¹⁵, T Burton ¹⁶, A L Bosma ¹, C‐C Chi ^17,¹⁸, G Fletcher ¹⁹, A M Drucker ²⁰, K Kabashima ^21,²², E F de Monchy ¹, M Panda ²³, D Wall ^19,²⁴, C Vestergaard ²⁵, E Mahé ²⁶, L Bonzano ²⁷, L Kattach ²⁸, M Napolitano ²⁹, M F Ordoñez‐Rubiano ³⁰, E Haufe ³¹, C Patruno ³², A D Irvine ^33,^✉, P I Spuls ^1,^✉, C Flohr ^2,^✉

^¹Department of Dermatology, Amsterdam UMC, location Academic Medical Center, University of Amsterdam, Amsterdam Public Health, Infection and Immunity, The Netherlands

^²Unit for Population‐Based Dermatology Research, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK

^³Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, UK

^⁴Dermatologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

^⁵Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy

^⁶Clinical Dermatology, IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy

^⁷Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy

^⁸PhD Degree Program in Pharmacological Sciences, Department of Pharmaceutical and Pharmacological Sciences, University of Padua, Padua, Italy

^⁹Dermatologia, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy

^¹⁰UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli ‐ IRCCS, Rome, Italy

^¹¹Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India

^¹²Department of Dermatology, Calcutta National Medical College, Kolkata, India

^¹³Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

^¹⁴Medical Practice Evaluation Center, Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

^¹⁵Dutch Association for People with Atopic Dermatitis (VMCE), Nijkerk, The Netherlands

^¹⁶Patient Representative (independent), Nottingham, United Kingdom

^¹⁷Department of Dermatology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan

^¹⁸College of Medicine, Chang Gung University, Taoyuan, Taiwan

^¹⁹National and International Skin Registry Solutions (NISR), Charles Institute of Dermatology, University College Dublin, Dublin, Ireland

^²⁰Department of Medicine, University of Toronto, Toronto, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Canada

^²¹Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan

^²²Singapore Immunology Network (SIgN) and Skin Research Institute of Singapore (SRIS), Agency for Science, Technology and Research (A*STAR), Biopolis, Singapore

^²³Department of DVL, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India

^²⁴Hair Restoration Blackrock, Dublin, Ireland

^²⁵Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark

^²⁶Service de Dermatologie et Médecine Vasculaire, Centre Hospitalier Victor Dupouy, 69 rue du Lieutenant‐Colonel Prud'hon, Argenteuil, Cedex, France

^²⁷Dermatology Unit, Azienda USL‐IRCCS di Reggio Emilia, Reggio Emilia, Italy

^²⁸Guy's & St. Thomas' Hospitals NHS Foundation Trust

^²⁹Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy

^³⁰Central Military Hospital, Bogota, Colombia

^³¹Center for Evidence‐based Health Care (ZEGV), Medical Faculty Carl Gustav Carus, TU Dresden, Dresden, Germany

^³²Dermatology and Venereology, Department of Health Sciences, University Magna Graecia of Catanzaro, Italy

^³³Clinical Medicine, Trinity College Dublin, Ireland

Correspondence , C. Flohr, P.I. Spuls, A.D. Irvine, Carsten Flohr, MA MSc PhD FRCP FRCPCH, Chair in Dermatology and Population Health Science, St John’s Institute of Dermatology, King’s College London And Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK, Email addresses: carsten.flohr@kcl.ac.uk, ph.i.spuls@amsterdamumc.nl, irvinea@tcd.ie

both authors contributed equally to this manuscript and should be considered joint first authors.

^✉

Corresponding author.

PMCID: PMC9537876 PMID: 36169355

Abstract

Background

Limited data are available on the effects of systemic immunomodulatory treatments on COVID‐19 outcomes in patients with atopic dermatitis (AD).

Objective

To investigate COVID‐19 outcomes in patients with AD treated with or without systemic immunomodulatory treatments, using a global registry platform.

Methods

Clinicians were encouraged to report cases of COVID‐19 in their patients with AD in the Surveillance Epidemiology of Coronavirus Under Research Exclusion for Atopic Dermatitis (SECURE‐AD) registry. Data entered from April 1^st 2020 to October 31^st 2021 were analyzed using multivariable logistic regression. The primary outcome was hospitalization from COVID‐19, according to AD treatment groups.

Results

442 AD patients (mean age 35.9 years, 51.8% male) from 27 countries with strongly suspected or confirmed COVID‐19 were included in analyses. 428 (96.8%) patients were treated with a single systemic therapy (n=297[67.2%]) or topical therapy only (n=131[29.6%]). Most patients treated with systemic therapies received dupilumab (n=216). 14 patients (3.2%) received a combination of systemic therapies. 26 patients (5.9%) were hospitalized. No deaths were reported. Patients treated with topical treatments had significantly higher odds of hospitalization, compared to those treated with dupilumab monotherapy (odds ratio (OR) 4.65[95%CI 1.71‐14.78]), including after adjustment for confounding variables (adjusted OR (aOR 4.99[95%CI 1.4‐20.84]). Combination systemic therapy which did not include systemic corticosteroids was associated with increased odds of hospitalization, compared to single agent non‐steroidal immunosuppressive systemic treatment (OR 8.09[95%CI 0.4‐59.96], aOR 37.57[95%CI 1.05‐871.11]). Hospitalization was most likely in patients treated with combination systemic therapy which included systemic corticosteroids (OR 40.43[95%CI 8.16‐207.49], aOR 45.75[95%CI 4.54‐616.22]).

Conclusions

Overall, the risk of COVID‐19 complications appears low in patients with AD, even when treated with systemic immunomodulatory agents. Dupilumab monotherapy was associated with lower hospitalization than other therapies. Combination systemic treatment, particularly combinations including systemic corticosteroids, was associated with the highest risk of severe COVID‐19.

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The effects of systemic immunomodulatory treatments on COVID‐19 outcomes in patients with atopic dermatitis: results from the global SECURE‐AD registry

A H Musters

C Broderick

D Prieto‐Merino

A Chiricozzi

G Damiani

K Peris

S Dhar

A De

E Freeman

B W M Arents

T Burton

A L Bosma

C‐C Chi

G Fletcher

A M Drucker

K Kabashima

E F de Monchy

M Panda

D Wall

C Vestergaard

E Mahé

L Bonzano

L Kattach

M Napolitano

M F Ordoñez‐Rubiano

E Haufe

C Patruno

A D Irvine

P I Spuls

C Flohr

Abstract

Background

Objective

Methods

Results

Conclusions

ACTIONS

PERMALINK

RESOURCES

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