Impact of the COVID-19 pandemic and lockdown on the clinical response to dupilumab treatment and the psychological status of non-infected atopic patients

Background: Dupilumab is an effective treatment for atopic dermatitis and was found to improve results of clinician- and patient-oriented tests with relevant benefits across multiple domains related to the disease. Objectives: To investigate the effects of significant psychological stress on clinician- and patient-oriented tests for severe AD patients treated with dupilumab. Patients were investigated before and during the COVID-19 pandemic and lockdown in a severely affected area. Materials & Methods: Forty-five adult patients suffering from severe AD were enrolled. Clinician-oriented (EASI, SCORAD and NRS scores for sleep loss and itching) and patient-oriented tests (DLQI, POEM and HADS) were administered at baseline (TO) and after 16 (T1) and 24 (T2) weeks. The T2 examination took place just before the outbreak of the COVID-19 pandemic. A further examination took place at 32 weeks (T3) during the COVID-19 pandemic and lockdown. Results: In comparison to baseline, dupilumab treatment rapidly improved the scores of all tests. After this, the pandemic and lockdown started, and scores of clinician-oriented tests remained almost stable, while patient-oriented scores markedly deteriorated, although they remained better than at baseline. Some personal and social situations seemed to be linked to a worse result. Conclusion: Despite dupilumab being effective in inducing and maintaining clinical remission of AD, the COVID-19 pandemic and lockdown significantly impaired patients' perception of the disease, quality of life and anxiety and/or depression. However, this psychological status did not modify the therapeutic response to dupilumab.