SARS-CoV-2 infection in the study population
Fifty-nine of 1831 (3.2%) AD patients performed in total 79 SARS-CoV-2 nasal-throat swab tests; 16/1831 (0.9%) had a confirmed diagnosis of SARS-CoV-2 infection and 3 (0.2%) were hospitalized. No cases of death from COVID-related disease occurred in our study population throughout the whole observation period. The 16 SARS-CoV-2 positive patients had a mean age of 45.1 years (±16.4), 9 were females (56.3%), presenting rhinitis as the most common atopic comorbidity 10/16 (62.5%) (Table 2). AD severity was in line with the overall patient population (data not shown). Comparing AD patients positive to SARS-CoV-2 nasal-throat swab testing with those who resulted negative, no significant difference in mean baseline EASI score was found (7.744 ± 2.062 for SARS-CoV-2 positive patients vs. 5.830 ± 0.9865 for SARS-CoV-2 negative patients, p=0.3577). Fifteen of 16 (93.8%) patients were undergoing dupilumab therapy when SARS-CoV-2 occurred (Table 2). Dupilumab was mostly used in monotherapy (80%, 13/15) while in 20.0% (3/15) of patients was combined with systemic corticosteroids and/or methotrexate. Half of SARS-CoV-2 positive patients discontinued treatment. SARS-CoV-2 positive patients who continued treatment were all undergoing dupilumab therapy and exhibited a significant reduction of mean EASI score from timepoint 1 to timepoint 3 (7.7 ± 2.1 at timepoint 1 vs. 2.3 ± 1.3 at timepoint 3, p=0.0468). Similarly, EASI score significantly decreased in patients discontinuing therapy overtime (timepoint 1: 9.9± 9.5 vs. timepoint 3: 0.4± 0.52, p=0.013). Neither dupilumab-related adverse events (i.e., injection site reaction or conjunctivitis) or COVID-19 complication or worsening were reported in those cases continuing therapy. Because of close contact with COVID-19 cases or high-risk conditions for SARS-CoV-2 infection, 3.2% (58/1831) of patients underwent quarantine.