Dupi y Covid-19

Journal Scan / Review · July 01, 2020

Risk of Dupilumab Use for Atopic Dermatitis During the COVID-19 Pandemic

Journal of the American Academy of Dermatology

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• To provide some guidance for patients on dupilumab during the COVID-19 pandemic, the authors summarized the infection rates associated with dupilumab use versus placebo from three randomized, placebo-controlled, phase III clinical trials (SOLO 1, SOLO 2, and CHRONOS). When combining the trials, the dupilumab group and placebo group had equal rates of overall infection (41%) and nasopharyngitis (13%). Upper respiratory tract infections were seen in 6% of patients receiving dupilumab versus 5% receiving placebo.

• There is limited knowledge of the effect of dupilumab on the clinical course of COVID-19 infection, although data from previous trials demonstrate that patients receiving dupilumab had the same rate of overall infection compared with those receiving placebo. Based on these findings, otherwise healthy patients with atopic dermatitis taking dupilumab during the COVID-19 pandemic should not be predisposed to infection.

– Margaret Hammond, MD

Written by

 

 

Andrew F. Alexis MD, MPH

Although data on the use of biologic medications during the COVID-19 pandemic are limited, this letter to the editor reviews safety data from previously published trials of dupilumab in atopic dermatitis to help inform risk of use in the era of COVID-19. Pooling data from three randomized, placebo-controlled, phase III clinical trials (SOLO 1, SOLO 2, and CHRONOS), the rate of infections among adult patients with atopic dermatitis treated with dupilumab was comparable with that among those treated with placebo. Although this supports current recommendations that include maintaining treatment with dupilumab in non–high-risk groups who do not have COVID-19, an important limitation of these data is that they are derived from a clinical trial population that may not be representative of many patients seen in the community setting, such as those who have multiple comorbid conditions (who would have been excluded from pivotal clinical trials). Given limited data, clinical judgement and careful consideration of potential risks and benefits in high-risk patients are paramount.

Abstract 

In the midst of the COVID-19 pandemic, physicians are using what's known of the SARS-CoV-2 virus to establish practice guidelines for dermatologic conditions, particularly in regard to the use of immunosuppressive medications.1 The effect of immunosuppressive medications on the clinical course of COVID-19 infection is currently unclear. While there is some evidence to support the use of targeted immunosuppressive medications against cytokine storm, there is concern that patients treated with biologic medications may have worse outcomes.1 Though knowledge regarding the risk of biologic use during the COVID-19 pandemic is extremely limited, we can use data from previous trials to extrapolate a medication's potential risk based on its infection rate when compared to placebo.

Journal of the American Academy of Dermatology

Assessing the Risk of Dupilumab Use for Atopic Dermatitis During the COVID-19 Pandemic

J Am Acad Dermatol 2020 Jun 10;[EPub Ahead of Print], DG Kearns, S Uppal, VS Chat, JJ Wu 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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