SARS-CoV-2 asymptomatic infection in a patient under treatment with dupilumab.

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Dear Editor,

We have read with great interest the letter of the European Task Force on Atopic Dermatitis on SARS‐CoV‐2 infection and atopic dermatitis published in JEADV (March 2020) in which the authors state: ‘Targeted treatment selectively interfering with type‐2 inflammation such as dupilumab is not considered to increase the risk for viral infections and might thus be preferred …in a situation such as COVID‐19 pandemic’.

We would like to report the case of a 72‐year‐old man affected by severe atopic dermatitis (histologically ascertained), who is under treatment with dupilumab since November 2019, with excellent clinical results.

At the beginning of SARS‐CoV‐2 pandemic in Italy, although he was totally asymptomatic for COVID‐19, as all the other residents in Vo’ Euganeo, a small town near Padua, in the so‐called ‘Vo’ Red Zone’ (i.e. restricted area), he was tested with nasopharyngeal swab for SARS‐CoV‐2 detection and resulted positive.

After 20 days of isolation period, the nasopharyngeal swab for SARS‐CoV‐2 resulted again positive. After 20 more days of isolation, he was tested positive for the third time. Three weeks later, the nasopharyngeal swab for SARS‐CoV‐2 was finally negative. Notwithstanding the risk factors (i.e. age >65 years and male gender), our patient throughout all this period (9 weeks) remained totally asymptomatic for COVID‐19, in good general condition and free of atopic dermatitis.

It would seem that treatment with dupilumab, similarly to other antibodies targeting pro‐inflammatory cytokines (e.g. adalimumab, infliximab, ustekinumab, secukinumab and guselkumab), does not worsen the condition of patients infected by SARS‐CoV‐2 or increase the risk of infection by SARS‐CoV‐2, , , , , , possibly because these antibodies neutralize individual mediators of the inflammation cascade rather than leading to broad immunosuppression.

However, of course, more robust clinical data are needed in order to evaluate the safety of dupilumab and of other biologics in patients infected by SARS‐CoV‐2.