Patients
We performed a cross-sectional analysis of reported demographics,
medical history, and medications from 1,237 moderate-to-severe AD
patients enrolled from April 2nd 2020 through January
31st, 2021 in a prospective registry related to
COVID-19 in the Department of Dermatology at the Icahn School of
Medicine at Mount Sinai. Patients were enrolled under institutional
review board-approved consent, and the study was conducted according to
the Declaration of Helsinki. The electronic medical record was queried
for all related ICD10 codes and each patient chart was reviewed to
ensure inclusion criteria were met. Patients were enrolled at the time
of clinical visit, when applicable, or enrolled over the phone.
Inclusion criteria included being older than 9 years of age with a
diagnosis of moderate-to-severe atopic dermatitis, defined as currently
or previously being on systemic therapy (including dupilumab,
phototherapy, or oral immunomodulatory medications), or as candidates
for systemic therapy.
Patients were asked about past medical history, medications,
demographics (i.e., age, gender, and self-reported race), as well as the
presence and duration of individual COVID-19-related symptoms, including
objective or subjective fever, sore throat, cough, congestion, headache,
fatigue, anosmia, dysgeusia, dyspnea, nausea, vomiting, diarrhea,
anorexia, and skin changes. Based on the symptoms described, each
patient was given a COVID-19 symptom severity score from 0-5: 0:
“asymptomatic”; 1: “mild disease” (no fever, no dyspnea, resolving
in <7 days, resembling a common cold); 2: “moderate disease”
(some fever and/or cough, or other lower respiratory symptoms, resolving
at home in 7-14 days); 3: “severe disease” (pneumonia, required
hospitalization, but resolved without intubation); 4: “very severe
disease” (required hospitalization, intubation, and other supportive
measures); 5: “fatal.”
One thousand two-hundred and thirty-seven patients were included in the
final analysis, out of 1,357 patients enrolled. In the final analysis,
we excluded patients treated concomitantly with dupilumab and other
systemic therapies (due to the hypothesis that dupilumab would reduce
symptom severity compared to other systemic treatments), patients on
dupilumab for <2 months (in order to allow for the proposed
effects of dupilumab to manifest), and patients on additional
immunomodulating therapies for other skin or extracutaneous indications
besides AD (including TNFα and IL-23/IL-17 antagonists).