COVID-19 Risk and AD

A retrospective cohort study in a research letter published in the Journal of the American Academy of Dermatology examined the risk between atopic dermatitis and COVID-19 risk.

A group of researchers investigated the risk of COVID-19 in individuals with atopic dermatitis (AD) in a research letter published in the Journal of the American Academy of Dermatology.1

The research was conducted using the Symphony Health-derived data from the COVID-19 Research Database, and it was controlled for demographic factors and comorbidities known or speculated to be COVID-19 risk factors and assess the risk of contracting COVID-19 in adults with AD treated with dupilumab (Dupixent; Sanofi and Regeneron).

The patients included in the data were aged 20 years or older and all had to have at least 2 diagnoses of AD prior to January 1, 2020, were included in the AD cohort. Patients with no record of AD diagnosis prior to January 1, 2020, were randomly placed in the control group in a 10:1 size ratio compared with the AD group, according to the article. Of note, individuals without known ethnicity or race, type of payment, and/or sex were then excluded. Only laboratory-confirmed cases of COVID-19 between January 1, 2020, and April 17, 2021, were identified.1

The AD and non-AD cohorts included 39,417 and 397,293 patients, respectively, the article continued. Poisson regression revealed a crude COVID-19 incidence rate ratio (IRR) of 1.41 (95% CI 1.34-1.48) for adults with AD compared with adults without AD. After adjusting for demographic factors and baseline comorbidities, the IRR remained statistically significant but was reduced to 1.18 (95% CI 1.12-1.24).1

A sensitivity analysis which included the participants with missing race or ethnicity, sex, and/or type of payment (to account for selection bias), found the risk of COVID-19 associated with AD remained unchanged (adjusted IRR 1.18).

“In another sensitivity analysis (to address potential type I error) including subjects aged 20-65 years with zip codes in California or New York and excluding subjects with comorbidities associated with COVID-19 (n = 32,857), the adjusted IRR point estimate was higher (1.31, 95% CI 1.11-1.53) than that in the main analysis,” the researchers wrote.

It was found that dupilumab was associated with lower risk of contracting COVID-19 (adjusted IRR 0.66, 95% CI 0.52-0.83) compared with no systemic medication and AD patients on dupilumab showed significantly lower associated risk of contracting COVID-19 infection compared with AD subjects exposed to prednisone, cyclosporine, and/or azathioprine. The investigation was limited by the inability to account for treatment duration and establish a strong causal relationship. Additionally, the assessment of disease burden according to diagnostic codes might have missed individuals who never underwent COVID-19 laboratory testing.

“In this large population-based study, we found small increased risk of contracting COVID-19 to be associated with AD in adults,” researcher wrote. “However, adult AD subjects had a higher prevalence of baseline comorbidities, previously identified as COVID-19 risk factors, compared with adults without AD. Our results were attenuated after adjusting for baseline comorbidities, suggesting that residual confounding may explain the remaining association.”


Wu is or has been an investigator, consultant, or speaker for AbbVie, Almirall, Amgen, Arcutis, Aristea Therapeutics, Boehringer Ingelheim, Bristol–Myers Squibb, Dermavant, Dr Reddy's Laboratories, Eli Lilly, Galderma, Janssen, LEO Pharma, Mindera, Novartis, Regeneron, Sanofi Genzyme, Solius, Sun Pharmaceutical, UCB, Valeant Pharmaceuticals North America LLC, and Zerigo Health.

Egeberg has received research funding from Pfizer, Eli Lilly, Novartis, Bristol-Myers Squibb, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Aage Bang's Foundation, and honoraria as consultant and/or speaker from AbbVie, Almirall, Leo Pharma, Galápagos NV, Sun Pharmaceuticals, Samsung Bioepis Co, Ltd, Pfizer, Eli Lilly, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol–Myers Squibb, and Janssen Pharmaceuticals.

Thyssen has been an advisor, speaker, or investigator for AbbVie, LEO Pharma, Regeneron, Pfizer, Sanofi Genzyme, Almirall, and Eli Lilly. Dr Ge and

Authors Martin, Liu, and Thatiparthi have no conflicts of interest to declare.


Wu JJ, Martin A, Liu J, et al. The risk of COVID-19 infection in patients with atopic dermatitis: A retrospective cohort study. Journal of the American Academy of Dermatology. 2022;86(1):243-245. doi:10.1016/j.jaad.2021.09.061