Immunosuppressive drugs for patients with psoriasis during the COVID ‐19 pandemic era. A review

Abstract

The COVID‐19 has been spreading around the world. Concerns about the safety of administration of immunosuppressive drugs have been raised for treatment of psoriasis (PSO), and there is insufficient evidence for the risk of COVID‐19 infection for psoriatic patients using these drugs, so we did a review, focusing on the risk of overall infection associated with the most commonly used immunosuppressive drugs, such as methotrexate, biologics, cyclosporin, Janus kinase inhibitors for the treatment of PSO. The data on the effect of immunosuppressive drugs on this virus may be ever‐changing and remains to be clear. We recommend the initiation and continuation of low‐risk immunomodulating drugs, such as Interleukin (IL)‐17, IL‐12/23, and IL‐23 inhibitors, for treatment of PSO during COVID‐19 era. For psoriatic patients with comorbidities switching to safer modalities such as systemic retinoids, apremilast, and home phototherapy is recommended. Immunosuppressive drugs should be withheld in psoriatic patients with the COVID‐19 infection.

Vitamin D and COVID‐19 in an immunocompromised patient with multiple comorbidities—A Case Report

“…Chronic renal failure was also found to be independently associated with poor clinical outcome 38 . Besides, given the long‐standing history of psoriasis in our patient (25 years), we also point out that several studies have found increased risk of serious infection (especially cutaneous and respiratory) in psoriatic patients independently on the therapy and other comorbidities 30,39,40 . The risk of serious infection in psoriatic patients was found to increase further with the severity of the disease 39 and the presence of either diabetes mellitus, obesity, age >60 years, 41,42 or history of smoking 42 .…”

“…In the other hand, immunosuppression can mitigate excessive inflammation. There are studies showing no increased risk of severe COVID‐19 manifestation in patients on immunosuppressive therapy, including methotrexate, 30,31 as well as reports that emphasize severe COVID‐19 course in such patients 32,33 . Accordingly, available data on the impact of variety of immunosuppressant therapy regarding COVID‐19 clinical course are inconclusive yet 30,34 .…”

“…There are studies showing no increased risk of severe COVID‐19 manifestation in patients on immunosuppressive therapy, including methotrexate, 30,31 as well as reports that emphasize severe COVID‐19 course in such patients 32,33 . Accordingly, available data on the impact of variety of immunosuppressant therapy regarding COVID‐19 clinical course are inconclusive yet 30,34 . Both, insufficient directed immune response and unpurposeful inflammatory overactivity are assumed to increase possibility of severe COVID‐19 manifestations in the elderly patients, as aging is known to impair considerably the efficacy of immunoregulatory mechanisms 35,36 .…”

Mild COVID-19 manifestation in multiple risk factor patient on methotrexate, who had been treated with UVB phototherapy and had sufficient plasma 25-OH-vitamin D3 level

“…In the other hand, immunosuppression can mitigate excessive inflammation. There are studies showing no increased risk of severe COVID-19 manifestation in patients on immunosuppressive therapy, including methotrexate 30,31 , as well as reports that emphasize severe COVID-19 course in such patients 32,33 . Accordingly, available data on the impact of variety of immunosuppressant therapy regarding COVID-19 clinical course are inconclusive yet 30,34 .…”

Home Phototherapy During the COVID-19 Pandemic

“…As officebased phototherapy services may struggle to implement mitigation strategies, home-based phototherapy is an increasingly viable treatment option. 1,4,5 Patient benefits of home therapy include improved treatment compliance; greater patient satisfaction; reduced travel/waiting time; and reduced long-term cost, including co-pays, depending on insurance coverage. 2,4 We aim to provide recommendations on home-based phototherapy during the pandemic.…”