- There is currently no data about the benefits or the risks of stopping immunomodulators/immunosuppressants during the COVID-19 outbreak.
- Pre-coronavirus pivotal trials for psoriasis show that patients under biologic therapies had respiratory infection rates similar to placebo.
- Price et al recommend:
- Consider stopping classic immunosuppressants and rituximab when viral symptoms present, especially with known or potential exposure.
- Continue TNF-alpha and IL- 17/12/23 inhibitors if viral symptoms are mild, consider stopping if viral symptoms worsen or high fever develops.
- Continue Dupilumab and Apremilast unless severe symptoms present.
These data come from analysis of four articles published in Journal of American Academy of Dermatology and Dermatologic Therapy. Price et al propose general considerations based on medication’s mechanism of action, administration method and pharmacokinetics/ pharmacodynamics. Lebwohl et al show the rate of infection in available biologic agents for psoriasis pre-coronavirus. Conforti et al ‘s letter to the editor is a reflexion on whether it is appropriate time to start immunosuppressive therapy with CsA/MTX/anti-TNF-. Di Lernia V. ‘s article is a response to Conforti et al where he says that immunosuppressive drugs may have additional effects to their known function, thus, instead of stopping current therapy, a case-by-case assessment seems more appropriate to treat patients with severe psoriasis.
- Conforti C., Giuffrida R., Dianzani C., et al (March 11, 2020) COVID-19 and psoriasis: Is it time to limit treatment with immunosuppressants? A call for action, Dermatologic Therapy. https://doi.org/10.1111/dth.13298
- Di Lernia V. (March 29, 2020) Antipsoriatic Treatments During COVID-19 Outbreak, Dermatologic Therapy. https://doi.org/10.1111/dth.13345
- Lebwohl M., Rivera-Oyola R., Murrell DF. (March 18, 2020) Should Biologics for Psoriasis Be Interrupted in the Era of COVID-19? Journal of American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.03.031
- Price KN., Frew JW., Hsiao JL., et al (March 26, 2020) COVID-19 and Immunomodulator/ Immunosuppressant Use in Dermatology, Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.03.046