Biologics increase the risk of SARS ‐ CoV ‐2 infection and hospitalization, but not ICU admission and death: Real‐life data from a large cohort during red‐zone declaration

Abstract

During COVID-19 outbreak there are discordant opinions toward the impact on biologics in psoriatic (PsO) patients. Thus we performed a single-center case-control study in Lombardia, the Italian region with the higher number of COVID-19 confirmed cases.We enrolled 1193 PsO patients treated with biologics and small molecules and we used the entire Lombardia population as controls. Notably, 17 PsO patients COVID-19 confirmed were quarantined at home and five hospitalized, no PsO patients were admitted to intensive care unit (ICU) or died. With respect to the general population of Lombardy, patients on biologics were at higher risk to test positive for 3.43 [95% confidence interval (CI) 2.25-5.73], P < .0001), to be self-quarantined at home (OR 9.05 [95% CI 5.61-14.61], P < .0001) and hospitalized (OR 3.59 [95% CI 1.49-8.63], P = .0044), however, not increased risk of ICU admission or death were found. PsO patients on biologics should be carefully monitored with telemedicine during COVID-19 outbreak and early treated at home to limit hospital overwhelm.

Addendum to S3-Guidelines Crohn’s disease and ulcerative colitis: Management of Patients with Inflammatory Bowel Disease in the COVID-19 Pandemic – open questions and answers

“…Without doubt, the overall risk of bacterial and viral infections is significantly increased in patients under immunosuppressive therapy or steroids; these drugs also cause increased mortality [39]. Epidemiological studies from Lombardy in Italy including 1,193 patients with psoriasis receiving biologics show an increased risk for infection, but not for severe disease, as defined by a need for intensive medical care, or death (see ▶ Table 3) [40].…”

“…Risk of SARS-CoV-2 infection in patients with psoriasis and biologic therapy (relative risk in comparison to the overall population)[40].…”

Contributions of dermatologists to COVID ‐19 research: A brief systematic review

“…Two hundred and twelve articles were comments, 73 were case reports or case-series, 12 were reviews, and only 1 was case-control study. 3 The included studies were published in 36 different journals.…”

Immunosuppressive and immunomodulator therapy for rare or uncommon skin disorders in pandemic days

“…Cytokine storm, which is an overstimulated immune response seen in COVID‐19 patients, causes aggravation of the disease, an increased need for intensive care and an increased risk of death 85 . These cytokines are proinflammatory cytokines such as TNF‐α, IL‐1, IL‐2, IL‐6, IL‐7, IL‐8, IL‐17 granulocyte macrophage colony stimulating factor (GM‐CSF), and macrophage inflammatory protein 1‐α 86,87 . Routine use of systemic corticosteroids to suppress these cytokines is currently not recommended 85 .…”

“…Biological agents intended to improve cytokine storm are being studied in China in two different studies registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn/abouten.aspx). In one of these studies adalimumab (ChiCTR2000030089), which is anti‐TNF, is being studied, whereas in the other, combination of ixekizumab (ChiCTR2000030703), which is an IL‐17 inhibitor, with a conventional antiviral, is being studied 87 . In the light of this information, although use of biological agents does not seem very disadvantageous for COVID‐19 pneumonia, it is still not clear.…”