Effect of immunosuppressive drugs in immune‐mediated inflammatory disease during the coronavirus pandemic

Giuliani, Federica; Gualdi, Giulio; Amerio, Paolo

doi:10.1111/dth.14204

Cited by 8 publications

(8 citation statements)

References 40 publications

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“…However, older age, comorbidities, and the use of non-biologic systemic therapy (particularly corticosteroids) increases the risk of severe COVID-19 disease and/or hospitalization in patients with IBD, PsO, or rheumatic IMIDs [26][27][28][29][30][31]. Biologic therapies (except for the B-cell depleting agent rituximab [32]) were not associated with an increased risk of developing severe COVID-19 [33,34], and some of these therapies may in fact be protective against COVID-19-related hospitalization and death among infected patients [26][27][28][29]35,36].…”

Section: Increased Risk Of Infections In Patients With Imidsmentioning

confidence: 99%

Response to Vaccines in Patients with Immune-Mediated Inflammatory Diseases: A Narrative Review

Garcillán¹,

Salavert

Regueiro

et al. 2022

Vaccines

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Patients with immune-mediated inflammatory diseases (IMIDs), such as rheumatoid arthritis and inflammatory bowel disease, are at increased risk of infection. International guidelines recommend vaccination to limit this risk of infection, although live attenuated vaccines are contraindicated once immunosuppressive therapy has begun. Biologic therapies used to treat IMIDs target the immune system to stop chronic pathogenic process but may also attenuate the protective immune response to vaccines. Here, we review the current knowledge regarding vaccine responses in IMID patients receiving treatment with biologic therapies, with a focus on the interleukin (IL)-12/23 inhibitors. B cell-depleting therapies, such as rituximab, strongly impair vaccines immunogenicity, and tumor necrosis factor (TNF) inhibitors and the cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) fusion protein abatacept are also associated with attenuated antibody responses, which are further diminished in patients taking concomitant immunosuppressants. On the other hand, integrin, IL-6, IL-12/23, IL-17, and B-cell activating factor (BAFF) inhibitors do not appear to affect the immune response to several vaccines evaluated. Importantly, treatment with biologic therapies in IMID patients is not associated with an increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or developing severe disease. However, the efficacy of SARS-CoV-2 vaccines on IMID patients may be reduced compared with healthy individuals. The impact of biologic therapies on the response to SARS-CoV-2 vaccines seems to replicate what has been described for other vaccines. SARS-CoV-2 vaccination appears to be safe and well tolerated in IMID patients. Attenuated but, in general, still protective responses to SARS-CoV-2 vaccination in the context of certain therapies warrant current recommendations for a third primary dose in IMID patients treated with immunosuppressive drugs.

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Section: Increased Risk Of Infections In Patients With Imidsmentioning

confidence: 99%

Response to Vaccines in Patients with Immune-Mediated Inflammatory Diseases: A Narrative Review

Garcillán¹,

Salavert

Regueiro

et al. 2022

Vaccines

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“…The next most frequent type of publication included approaches to skin disease during the pandemic. These articles covered the management of a great variety of skin conditions during the pandemic, addressing the risk and impact of SARS-CoV-2 infection in dermatological patients, including psoriasis, oncologic disease, hidradenitis suppurativa, and lymphomas [12,[19][20][21]. Only 37 papers were about disease pathology research in patients with SARS-CoV-19-induced skin manifestations.…”

Section: Discussionmentioning

confidence: 99%

Dermatology Publications on COVID-19 during the First Pandemic Year: Creativity or Opportunism?

Amerio

Giuliani

Coppola

et al. 2023

Life

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Introduction: Dermatologists had to face several challenges during the COVID-19 pandemic. In this scenario, a large amount of data has been produced and published. Objectives: We present a literature analysis of publications on COVID-19 in the dermatology field in the first year of the pandemic. Methods: The research was carried out by searching the PubMed database using keywords related to “COVID-19” combined with the keyword “Dermatology” in the “affiliation” search field and collecting articles published from February 2020 to December 2020. Results: A total of 816 publications from 57 countries were retrieved. Overall, publications increased notably along the timespan considered in this study and appeared to be closely linked to pandemic progression in different countries. In addition, article types (i.e., commentaries, case reports, original research) appeared to be strictly influenced by the pandemic’s progression. However, the number and category of these publications may raise questions regarding the scientific relevance of the messages reported. Conclusions: Our analysis provides a descriptive quantitative analysis and suggests that publications do not always respond to real scientific needs but are sometimes linked to a need/opportunity for publication.

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“…The effect of immunomodulant/immunosuppressive compounds on the clinical course of COVID-19 is currently unclear, and there is concern of an increased risk of infection in AD patients treated with systemic compounds, though the continuation of therapy during pandemic was recommended by national and international scientific societies. [2][3][4][5][6][7] Nevertheless, immunomodulant/immunosuppressive agents, such as methotrexate, mycophenolate, azathioprine, and cyclosporine, were suggested to be tapered to the lowest effective dose, likely avoiding disease flare, and to consider drug discontinuation in patients when viral symptoms are present. 2,5 Similarly, caution was recommended in prescribing systemic corticosteroids given their broad immunosuppressive effects.…”

Section: Introductionmentioning

confidence: 99%

“…Thereby, COVID‐19 pandemic led to the sudden need of increasing the use of web and phone consulting, and defining practical guidelines for the management of immune‐mediated dermatologic conditions, such as AD that in moderate‐to‐severe cases are commonly treated with systemic immunomodulant/immunosuppressive compounds or phototherapy. The effect of immunomodulant/immunosuppressive compounds on the clinical course of COVID‐19 is currently unclear, and there is concern of an increased risk of infection in AD patients treated with systemic compounds, though the continuation of therapy during pandemic was recommended by national and international scientific societies 2‐7 . Nevertheless, immunomodulant/immunosuppressive agents, such as methotrexate, mycophenolate, azathioprine, and cyclosporine, were suggested to be tapered to the lowest effective dose, likely avoiding disease flare, and to consider drug discontinuation in patients when viral symptoms are present 2,5 .…”

Section: Introductionmentioning

confidence: 99%

Management of patients with atopic dermatitis undergoing systemic therapy during COVID‐19 pandemic in Italy: Data from the DA‐COVID‐19 registry

Chiricozzi

Talamonti

Simone

et al. 2021

Allergy

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Background Few and small studies have described the management of immunomodulant/immunosuppressive therapies or phototherapy in atopic dermatitis (AD) patients during coronavirus disease 2019 (COVID‐19) pandemic. Methods A national registry, named DA‐COVID‐19 and involving 35 Italian dermatology units, was established in order to evaluate the impact of COVID‐19 pandemic on the management of adult AD patients treated with systemic immunomodulant/immunosuppressive medications or phototherapy. Demographic and clinical data were obtained at different timepoints by teledermatology during COVID‐19 pandemic, when regular visits were not allowed due to sanitary restrictions. Disease severity was assessed by both physician‐ and patient‐reported assessment scores evaluating itch intensity, sleep disturbances, and AD severity. Results A total of 1831 patients were included, with 1580/1831 (86.3%) continuing therapy during pandemic. Most patients were treated with dupilumab (86.1%, 1576/1831) that was interrupted in only 9.9% (156/1576) of cases, while systemic immunosuppressive compounds were more frequently withdrawn. Treatment interruption was due to decision of the patient, general practitioner, or dermatologist in 39.9% (114/286), 5.6% (16/286), and 30.1% (86/286) of cases, respectively. Fear of increased susceptibility to SARS‐CoV‐2 infection (24.8%, 71/286) was one of the main causes of interruption. Sixteen patients (0.9%) resulted positive to SARS‐CoV‐2 infection; 3 of them (0.2%) were hospitalized but no cases of COVID‐related death occurred. Conclusions Most AD patients continued systemic treatments during COVID pandemic and lockdown period, without high impact on disease control, particularly dupilumab‐treated patients.

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Effect of immunosuppressive drugs in immune‐mediated inflammatory disease during the coronavirus pandemic

Cited by 8 publications

References 40 publications

Response to Vaccines in Patients with Immune-Mediated Inflammatory Diseases: A Narrative Review

Response to Vaccines in Patients with Immune-Mediated Inflammatory Diseases: A Narrative Review

Dermatology Publications on COVID-19 during the First Pandemic Year: Creativity or Opportunism?

Management of patients with atopic dermatitis undergoing systemic therapy during COVID‐19 pandemic in Italy: Data from the DA‐COVID‐19 registry

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