Systemic immunobiological, immunosuppressant, and oncologic agents for the treatment of dermatologic diseases during theSARS‐CoV‐2 (COVID‐19) pandemic emergency: A quick review for a quick consultation

Abstract

The Precision Medicine Era has helped to better manage patients with immunological and oncological disease, improving the quality of life of this class of patients. Regarding the management of these patients and positivity to SARS-Cov2, currently, limited data is available and information is evolving. In this quick review we have analyzed the mechanisms of action and related infective risk of drugs used for the treatment of immune-mediated and oncologic skin conditions during the daily clinical practice. In general immunosuppressant and antineoplastic agents for dermatologic treatments do not require suspension and do not require special measures, if not those commonly observed. In the case of a COVID19 patient with complication (such as pneumonia, respiratory failure), treatment suspension should always be considered after taking into account the general condition of the patient, the risk-benefit ratio and the pathophysiology of COVID19 infection. The COVID19 emergency pandemic does not imply an under-treatment of existing skin conditions, which together with the SARS-Cov2 infection may jeopardize the patient's life.

Patients with specific skin disorders who are affected by COVID ‐19: What do experiences say about management strategies? A systematic review

“…At the time of the pandemic, many patients were diagnosed with various dermatoses treated with biological agents or immunosuppressive/ immunomodulators. 57 Although, there is still no strong evidence T A B L E 1 (Continued) of a higher risk of infection with COVID-19 in these patients, and clinicians emphasizes that the symptoms and management of disease in these patients are similar to those in the general population. 26 In addition, for many dermatoses like other medical problems, any mental or physical stress, such as anxiety or infection, may exacerbate the disease course.…”

Impact of COVID-19 on dermatology practice. Comments from Jordan

“…Uważa się, że modulacja działania cytokin przyczynia się do zapobiegania uszkodzeniom płuc w przebiegu zakażeń wirusowych. Z tego względu skuteczność i bezpieczeństwo niektórych leków immunobiologicznych, między innymi tocilizumabu, są badane pod kątem leczenia COVID-19 [8]. Dostępnych jest niewiele danych, które pozwoliłyby sformułować zalecenia dotyczące stosowania przez pacjentów leków immunosupresyjnych, tj.…”

“…The immunological response to COVID-19 includes increased production of many cytokines which play a role in the pathogenesis of this disease. During this pandemic, the use of immunosuppressant and immuno-biological therapy for dermatological patients is an area of question, especially because modulation of cytokines' effects is believed to have a role in the prevention of lung damage in viral infections, which is why the efficacy and safety of some immuno-biological agents such as tocilizumab are under study for the treatment of COVID-19 [8]. There is little evidence off whether to discontinue, reduce the dose or continue the use of immunosuppressant agents.…”

“…Although there is no evidence associating COVID-19 complications with the use of systemic cancer therapy, patients who are on ICIs should be monitored regularly, with some studies even suggesting delaying the treatment with ICIs for patients who are showing COVID-19 symptoms [8].…”

Digital Clinician–Patient Consultation for Dermatology Care in Stressful COVID-19 Environment

“…These digital consultations have also permitted for the postponement of scheduled in-person appointments and elective surgeries, delivery of regular follow-up for established patients, and postoperative monitoring. The remarkably rapid rate of COVID-19-based data generation has been helpful for shared decision-making processes in challenging scenarios, such as the use of immunosuppressive and immunomodulatory therapies ( 4 ).…”