Severe Acute Respiratory Syndrome Coronavirus 2 and the Use of Biologics in Patients With Psoriasis

Abstract

Coronavirus disease (COVID-19), a respiratory disease caused by a novel coronavirus designated severe acute respiratory syndrome coronavirus 2, has rapidly spread worldwide and has been recognized as a pandemic by the World Health Organization. Patients with altered immunologic function are at higher risk of acquiring COVID-19. In patients with psoriasis, inhibition of select pro-inflammatory cytokines through the use of biologic agents has been shown to be an effective treatment option. Pro-inflammatory cytokines have key immunomodulatory effects and are known to be involved in the hosts’ immune response to a variety of viral infections. Though little is currently known about the role of inflammatory cytokines in COVID-19, early reports have shown patients with severe disease to have elevated serum levels of select inflammatory cytokines such as tumor necrosis factor alpha. This review will summarize key information that is currently known about COVID-19, the role of select cytokines in viral defense, and important considerations for patients with psoriasis using biologic agents during this pandemic. Currently, there is insufficient evidence to discontinue biologic therapy in patients with psoriasis who have not tested positive for COVID-19. The decision to pause biologic therapy should be considered on a case-by-case basis in patients in higher risk populations, and should take into account individual risk and benefit. Until more is known about the impact of biologic therapy on COVID-19 outcomes, we recommend patients with psoriasis who test positive for COVID-19 be instructed to discontinue or postpone biologic treatment until they have recovered from infection.

Healthcare Providers Face Numerous Challenges in Treating Patients with Psoriasis: Results from a Mixed-Methods Study

“…For instance, some biologic agents for psoriasis inhibit pro-inflammatory cytokines and may potentially increase risk of infection, which further complicates treatment decisions during the COVID-19 pandemic. 16 Finally, communicating and collaborating on patient comanagement emerged as a challenge. This finding is particularly salient due to the complexity of distinguishing psoriasis symptoms from other diseases, the nature of symptoms presented to primary care, and the variety of treatments and their side effects, which often requires the involvement of specialists.…”

“…For instance, some biologic agents for psoriasis inhibit pro-inflammatory cytokines and may potentially increase risk of infection, which further complicates treatment decisions during the COVID-19 pandemic. 16…”

The Risk of COVID-19 Pandemic in Patients with Moderate to Severe Plaque Psoriasis Receiving Systemic Treatments

“…The influence of biologics on respiratory tract infection susceptibility has recently been investigated. Higher risks of opportunistic infections and herpes zoster were reported among patients receiving immunosuppressive therapy to treat moderate-to-severe psoriasis [27]. TNF-α is expressed in the lung epithelial cells in response to respiratory viruses, such as influenza, and it recruits lympho-monocytes in the site of infection.…”

Biologics for Psoriasis During the COVID-19 Pandemic

“…However, it is inappropriate to speculate the susceptibility of SARS-CoV2 according to these previous studies because these studies did not analyze the risk of virus infection separately. More importantly, a published study suggested that the SARS, which has similar pathogenesis with SARS-CoV-2, may have a different immune response compared with other respiratory viruses ( 11 ). In the pandemic era, explaining the relationship between biologics and coronavirus infection is imperative.…”