Support for COVID-19 Vaccination in Patients With AD

The European Task Force on Atopic Dermatitis (ETFAD) suggests atopic dermatitis (AD) is not a contraindication to vaccination against COVID-19, despite the lack of evidence as to whether COVID-19 vaccination could briefly worsen AD. The ETFAD published their position on COVID-19 vaccination in the Journal of the European Academy of Dermatology and Venereology.

The organization added in their new position paper that there is currently a lack of evidence to suggest AD is an independent risk factor for COVID-19 or for severe COVID-19 beyond that observed with obesity, diabetes, and cardiovascular disease.

In addition, the ETFAD says that although there is a paucity of research to link COVID-19 vaccination to a brief worsening of AD, this may not be likely given a vaccination response is primarily T helper cell 1 skewed. Some treatments for AD, including systemic immunosuppressants and JAK-inhibitors, may attenuate the vaccination response, but the ETFAD cites research suggesting there is no expected attenuation for dupilumab.

The ETFAD adds that the risk-benefit ratio for authorized COVID-19 vaccines in the context of AD appears better than the risk for an infection with the novel coronavirus.

At the onset of the COVID-19 pandemic, the ETFAD released a position statement that described support for the continuation of systemic immune-modulating treatments in patients with AD. No clear evidence exists to suggest or recommend the temporary discontinuation of systemic AD medications before or following a COVID-19 vaccination.

Since a temporary 2-week pause of methotrexate may improve the immunogenicity of the seasonal influenza vaccine in patients with rheumatoid arthritis, the ETFAD notes that clinicians may consider pausing immunosuppressant during vaccination. The organization reminds these clinicians that patients on immunosuppressive agents for AD “will need a case-by-case approach “considering the specific drug and vaccine product,” but an “inadequate antibody response in selected individuals is not a major concern and the risk/benefit of vaccination is considered favorable for the overall AD population.”

The organization concluded their position statement by encouraging clinicians to register their patients with AD and COVID-19 in the ETFAD- supported SECURE-AD register, which is also set up to capture patients’ experiences with COVID-19 vaccination.

Disclosure: Several study authors declared affiliations with the pharmaceutical or biotech industries. Please see the original reference for a full list of authors’ disclosures.

Reference

Thyssen JP, Vestergaard C, Barbarot S, et al. European Task Force on Atopic Dermatitis: position on vaccination of adult patients with atopic dermatitis against COVID-19 (SARS-CoV-2) being treated with systemic medication and biologics. J Eur Acad Dermatol Venereol. Published online February 15, 2021. 2021;10.1111/jdv.17167. doi:10.1111/jdv.17167