- Recommendations for AIBD patients undergoing immunosuppressive therapy during the pandemic :
- Immunomodulatory therapy should be maintained when necessary since unjustified withdrawal could lead to uncontrolled AIBD activity.
- Adhere to standard precautions including social distancing and hand washing.
- What if AIBD patients are SARS-CoV-2 infected ?
- Evaluate the risk for each patient.
- May be stopped during COVID-19 symptoms: azathioprine, mycophenolate mofetil/sodium, cyclophosphamide and methotrexate.
- Can be continued : topical corticosteroids, prednis(ol)one <10 mg/day, dapsone/sulfapyridine, doxycycline/tetracycline, colchicine and IVIG.
- Consider dose reduction of prednis(ol)one >10 mg/day depending of the activity of AIBD, age, co-morbidities and severity of COVID-19.
- Avoid abrupt termination or reduction of systemic corticosteroids.
- Consider postponing rituximab infusions temporarily in pemphigus treatment.
- The French Society of Dermatology published an informative document for autoimmune bullous diseases patients.
These statements come from expert advices on the management of autoimmune bullous diseases (Kasperkiewicz et al) and more specifically pemphigus (Sharkshouk et al) since these conditions are treated with corticosteroids and non-steroid immunomodulatory agents. Thus, AIBD patients may be at higher risk of worst COVID-19 outcomes.
- Kasperkiewicz M., Schmidt E., Fairley J.A., et al (April 25, 2020) Expert recommendations for the management of autoimmune bullous diseases during the COVID-19 pandemic, Journal of the European Academy of Dermatology and Venereology. https://doi.org/10.1111/jdv.16525
- Shakshouk H., Daneshpazhooh M., Murrell D.F., et al (April 10, 2020) Treatment considerations for patients with pemphigus during the COVID-19 pandemic, Journal of the American Academy of Dermatology. https://doi.org/10.1016/j.jaad.2020.04.005
- Société française de dermatologie. (April 28, 2020) Informations sur le COVID-19 pour les personnes suivies pour une maladie bulleuse auto-immune. Retrieved from https://evenements-sfd.fr/coronavirus-covid-19/