Considerations for safety in the use of systemic medications for psoriasis and atopic dermatitis during theCOVID‐19 pandemic

Abstract

Coronavirus disease 2019 (COVID-19) is responsible for at least 2 546 527 cases and 175 812 deaths as of April 21, 2020. Psoriasis and atopic dermatitis (AD) are common, chronic, inflammatory skin conditions, with immune dysregulation as a shared mechanism; therefore, mainstays of treatment include systemic immunomodulating therapies. It is unknown whether these therapies are associated with increased COVID-19 susceptibility or worse outcomes in infected patients. In this review, we discuss overall infection risks of nonbiologic and biologic systemic medications for psoriasis and AD and provide therapeutic recommendations. In summary, in patients with active infection, systemic conventional medications, the Janus kinase inhibitor tofacitinib, and biologics for psoriasis should be temporarily held until there is more data; in uninfected patients switching to safer alternatives should be considered. Interleukin (IL)-17, IL-12/23, and IL-23 inhibitors are associated with low infection risk, with IL-17 and IL-23 favored over IL-12/23 inhibitors. Pivotal trials and postmarketing data also suggest that IL-17 and IL-23 blockers are safer than tumor necrosis factor alpha blockers. Apremilast, acitretin, and dupilumab have favorable safety data and may be safely initiated and continued in uninfected patients. Without definitive COVID-19 data, these recommendations may be useful in guiding treatment of psoriasis and AD patients during the COVID-19 pandemic.

COVID ‐19 patients with psoriasis and psoriatic arthritis on biologic immunosuppressant therapy vs apremilast in North Spain

“…Therefore, apremilast where apremilast and acitretin are the only two drugs proposed by the authors to continue or initiate psoriasis therapy. 7 Results in realworld settings have further reinforced the safety and efficacy of apremilast on psoriasis patients during the COVID-19 pandemic. 13 In conclusion, apremilast does not seem to particularly increase susceptibility to infection and can be considered a safe alternative for both infected and uninfected COVID-19 patients.…”

“…2,4 With daily media warnings and dozens of articles published on the pandemic, patients and physicians are concerned on the possible higher risk of being infected, and whether they need to discontinue their biologic treatment preemptively. 1,2,[4][5][6][7] Moreover, these patients are often at greater risk of developing cardiovascular disease, Rubén Queiro Silva and Susana Armesto contributed equally to this study. depression, and other health conditions, which might increase the severity of the COVID-19 infection.…”

“…1,3,6,9 On the other hand, discontinuing biologics can result in loss of response when treatments are reintroduced, or even result in the formation of antibodies to the discontinued biologic. 6 Some physicians consider that immunosuppressant therapies should be suspended or reassessed until the infection is solved, 4,7,9 while others argue that this might be a premature decision considering the available evidence. 6.…”

The impact of COVID-19 pandemic in a cohort of Italian psoriatic patients treated with biological therapies

“…Patients with severe disease require regular dermatologic consultations, which were suddenly interrupted due to the shutdown of most of psoriasis outpatient services, and these patients are also frequently treated with chronic systemic immunomodulatory therapies. While there is general consensus about stopping systemic therapies in psoriatic patients who become COVID-19 positive (6,7), different opinions have been expressed among the scientific community regarding whether biologic and immunomodulatory treatments for psoriasis and other immune-mediated diseases should be continued or interrupted during the pandemic (8,9). As a result, many national and international societies proposed specific recommendations to help both physicians and patients to face the pandemic (10-13).…”

Dupilumab in atopic dermatitis, a protocol for SARS‐COV‐ 2‐infected patients

“…2 Also, by treating asthma dupilumab may theoretically decrease risk for COVID-19 and severe respiratory disease. 4 In Latin America COVID-19 is rapidly spreading, in Colombia numbers are increasing, positioning us now as the second country with the most cases in Latin America and it has encountered our AD clinic.…”