Examining recommendations for the use of biologics and other systemic therapies during COVID-19: a review and comparison of available dermatology guidelines and patient registries

Abstract

Background: The novel coronavirus has an affinity for almost every organ system, including the skin. This review article will compile and compare dermatology guidelines related to the dermatologic care of patients during the COVID-19 pandemic. Objective: To review and compare the available guidelines and recommendations on use of biologics and other systemic therapies in dermatology patients. Methods: We conducted a search for guidelines and recommendations for dermatology providers, with specific attention to the management of biologics and non-biologic systemic agents during COVID-19. International and United States-based guidelines specific to the field of dermatology and guidance for healthcare providers were used as inclusion criteria. Available registries were included as well. Conclusion:The guidelines stress a shared decision-making approach with risk-benefit analysis and treatment strategy modifications tailored to each unique patient case. The guidelines were all concordant with one another in highlighting the importance that patients should not discontinue their medications without first speaking with their providers.

The Risk of COVID-19 Pandemic in Patients with Moderate to Severe Plaque Psoriasis Receiving Systemic Treatments

“…People with psoriasis undergoing systemic therapy should be advised to follow current guidelines for hygiene and physical distancing as recommended in their respective area of residence. Given that this is a novel and rapidly changing situation, recommendations may be modified as more data become available [52].…”

Evidence for the Use of Secukinumab in Patients with Radiographic and Non-radiographic Axial Spondyloarthritis in the Last 5 Years

“…A population-based cohort study of psoriasis patients in Israel indicated that IL-17A inhibitor treatment was not associated with an increased risk of developing COVID-19 infection, hospitalization or mortality compared with methotrexate or with non-systemic/non-immunomodulatory agents [ 80 ]. Current recommendations advise continuing biological therapy in patients who do not have severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection, and temporarily discontinuing treatment in those who test positive for the infection [ 81 ].…”

“…Anecdotal data suggest that some patients with psoriasis discontinued treatment with their biological therapy because they feared that it would increase their risk of developing COVID-19 infection [ 82 ]. This highlights the need for individualized treatment decisions and good communication between patients and physicians about the risks and benefits of treatment versus no treatment during the COVID-19 pandemic [ 81 , 82 ].…”

Biologics for Psoriasis During the COVID-19 Pandemic

“…For those patients who are qualified for biological treatment but have not yet started, it is advisable to carefully assess the balance of benefits and risks of treatment for each patient. In populations with a high risk for severe COVID-19, a postponement of biological treatment or other therapeutic options should be considered (79)(80)(81). The National Psoriasis Foundation COVID-19 Task Force has reiterated a similar point in the guidance for the management of psoriatic disease during the pandemic.…”