Biologics for Psoriasis During the COVID-19 Pandemic

Abstract

Coronavirus disease 2019 (COVID-19), a new form of acute infectious respiratory syndrome first reported in 2019, has rapidly spread worldwide and has been recognized as a pandemic by the WHO. It raised widespread concern about the treatment of psoriasis in this COVID-19 pandemic era, especially on the biologics use for patients with psoriasis. This review will summarize key information that is currently known about the relationship between psoriasis, biological treatments, and COVID-19, and vaccination-related issues. We also provide references for dermatologists and patients when they need to make clinical decisions. Currently, there is no consensus on whether biological agents increase the risk of coronavirus infection; however, current research shows that biological agents have no adverse effects on the prognosis of patients with COVID-19 with psoriasis. In short, it is not recommended to stop biological treatment in patients with psoriasis to prevent the infection risk, and for those patients who tested positive for SARS-CoV-2, the decision to pause biologic therapy should be considered on a case-by-case basis, and individual risk and benefit should be taken into account. Vaccine immunization against SARS-CoV-2 is strictly recommendable in patients with psoriasis without discontinuation of their biologics but evaluating the risk-benefit ratio of maintaining biologics before vaccination is mandatory at the moment.

Complexity of the Immune Response Elicited by Different COVID-19 Vaccines, in the Light of Natural Autoantibodies and Immunomodulatory Therapies

“…It has long been known that in the pathogenesis of psoriasis, a self-sustaining cycle of inflammation plays an important role. This is mediated mainly by T cells and cytokines such as TNFα, IL-23 and IL-17 [ 41 , 42 ]. Biological agents targeting these cytokines are key players in the treatment of psoriasis [ 42 ].…”

“…This is mediated mainly by T cells and cytokines such as TNFα, IL-23 and IL-17 [ 41 , 42 ]. Biological agents targeting these cytokines are key players in the treatment of psoriasis [ 42 ]. Anti-TNFα and anti-IL-17 are prominent examples for different classes of biologics that are used to treat moderate-to-severe psoriasis and hidradenitis suppurativa [ 43 ].…”

“…Additionally, compared with the placebo group, anti-TNFα-treated patients showed a moderate increase in susceptibility to upper respiratory infections (URIs) [ 49 ]. Though serum levels of TNFα have been noted to be elevated in patients with viral respiratory illnesses such as influenza, no significant elevation of TNFα was detected in the serum of patients with SARS, suggesting that the immune response to SARS may differ from that of other respiratory illnesses [ 42 ].…”

Clinical characteristics and outcomes of patients with COVID‐19 and psoriasis

“…Systemic and biologic therapy represents an important breakthrough in the treatment of psoriasis patients, 21 while extensive debate has been proposed for the use of these treatments in patients with COVID‐19 and psoriasis. 22 , 23 , 24 , 25 On one hand, the use of these treatments could control the psoriasis severity. 13 , 26 On the other hand, the achieved immunosuppression could increase the risk of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, interfere with antiviral immunity, and worsen clinical outcomes.…”

“…Systemic and biologic therapy represents an important breakthrough in the treatment of psoriasis patients, 21 while extensive debate has been proposed for the use of these treatments in patients with COVID‐19 and psoriasis 22–25 . On one hand, the use of these treatments could control the psoriasis severity 13,26 .…”