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Management of patients with atopic dermatitis undergoing systemic therapy during COVID-19 pandemic in Italy: Data from the DA-COVID-19 registry
Authors:Andrea Chiricozzi  Marina Talamonti  Clara De Simone  Marco Galluzzo  Niccolò Gori  Gabriella Fabbrocini  Angelo Valerio Marzano  Giampiero Girolomoni  Annamaria Offidani  Maria Teresa Rossi  Luca Bianchi  Antonio Cristaudo  Maria Teresa Fierro  Luca Stingeni  Giovanni Pellacani  Giuseppe Argenziano  Annalisa Patrizi  Paolo Pigatto  Marco Romanelli  Paola Savoia  Pietro Rubegni  Caterina Foti  Nicola Milanesi  Anna Belloni Fortina  Maria Rita Bongiorno  Teresa Grieco  Sergio Di Nuzzo  Maria Concetta Fargnoli  Andrea Carugno  Alberico Motolese  Franco Rongioletti  Paolo Amerio  Riccardo Balestri  Concetta Potenza  Giuseppe Micali  Cataldo Patruno  Iris Zalaudek  Maurizio Lombardo  Claudio Feliciani  Lucia Di Nardo  Fabrizio Guarneri  Ketty Peris  DA-COVID- study group
Institution:1. Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy;2. Dermatology Unit, Policlinico Tor Vergata, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy;3. Dermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy

Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy;4. Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy;5. Dermatology Unit, Fondazione IRCCS Ca, Granda Ospedale Maggiore Policlinico, Milan, Italy

Department of Pathophysiology and Transplantation, UniversitàdegliStudi di Milano, Milan, Italy;6. Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy;7. Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, Italy;8. Department of Dermatology, ASST Spedali Civili of Brescia, University of Brescia, Brescia, Italy;9. Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy;10. Medical Sciences Department, Dermatologic Clinic, University of Turin, Turin, Italy;11. Dermatology Section, Department of Medicine, University of Perugia, Perugia, Italy;12. Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy;13. Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy;14. Dermatology UOC, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy;15. Department of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, Milan, Italy;16. Department of Dermatology, University of Pisa, Pisa, Italy;17. Department of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, Italy;18. Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy;19. Department of Biomedical Science and Human Oncology, Unit of Dermatology, University of Bari, Bari, Italy;20. Dermatology Clinic, Department of Health Sciences, University of Florence, Florence, Italy;21. Dermatology Unit - Department of Medicine DIMED, University of Padova, Padova, Italy;22. Section of Dermatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy;23. Unit of Dermatology, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy;24. Department of Medicine and Surgery, Section of Dermatology, University of Parma, Parma, Italy;25. Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy;26. Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy;27. Dermatology Unit, Department of MedicalSpecialties, Arcispedale Santa Maria Nuova-IRCCS di Reggio Emilia, Reggio Emilia, Italy;28. Vita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, Italy;29. Department of Medicine and Aging Science, Dermatologic Clinic, G. D'Annunzio University, Chieti, Italy;30. Division of Dermatology, Santa Chiara Hospital, Trento, Italy;31. Department of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit, Daniele Innocenzi, Sapienza, University of Rome - Polo Pontino, Rome, Italy;32. Dermatology Clinic, University of Catania, Catania, Italy;33. Dermatology Unit, Department of Health Sciences, Università Magna Graecia, Catanzaro, Italy;34. Department of Dermatology, University of Trieste, Trieste, Italy;35. Unit of DermatologicalDiseases, ASST Sette Laghi, Ospedale di Circolo, Varese, Italy;36. Dermatology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy;37. DA-COVID-19 Study Group are listed in Appendix 38. 1.
Abstract:

Background

Few and small studies have described the management of immunomodulant/immunosuppressive therapies or phototherapy in atopic dermatitis (AD) patients during coronavirus disease 2019 (COVID-19) pandemic.

Methods

A national registry, named DA-COVID-19 and involving 35 Italian dermatology units, was established in order to evaluate the impact of COVID-19 pandemic on the management of adult AD patients treated with systemic immunomodulant/immunosuppressive medications or phototherapy. Demographic and clinical data were obtained at different timepoints by teledermatology during COVID-19 pandemic, when regular visits were not allowed due to sanitary restrictions. Disease severity was assessed by both physician- and patient-reported assessment scores evaluating itch intensity, sleep disturbances, and AD severity.

Results

A total of 1831 patients were included, with 1580/1831 (86.3%) continuing therapy during pandemic. Most patients were treated with dupilumab (86.1%, 1576/1831) that was interrupted in only 9.9% (156/1576) of cases, while systemic immunosuppressive compounds were more frequently withdrawn. Treatment interruption was due to decision of the patient, general practitioner, or dermatologist in 39.9% (114/286), 5.6% (16/286), and 30.1% (86/286) of cases, respectively. Fear of increased susceptibility to SARS-CoV-2 infection (24.8%, 71/286) was one of the main causes of interruption. Sixteen patients (0.9%) resulted positive to SARS-CoV-2 infection; 3 of them (0.2%) were hospitalized but no cases of COVID-related death occurred.

Conclusions

Most AD patients continued systemic treatments during COVID pandemic and lockdown period, without high impact on disease control, particularly dupilumab-treated patients.
Keywords:atopic dermatitis  COVID  SARS-CoV
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