Is It Possible to Discontinue Tumor Necrosis Factor Antagonists after Psoriasis Remission?

Kim, Byung‐Soo; Maverakis, Emanual; Raychaudhuri, Siba P

doi:10.5021/ad.2019.31.5.495

Cited by 6 publications

(3 citation statements)

References 31 publications

(15 reference statements)

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“…However, definitive evidences that antipsoriatic biologics increase the risk of infectious complica- Furthermore, the unavoidable subsequent return to biologic therapy could be associated with switching toward higher cost drugs, due to the well-known lower efficacy of biologics in the same patient after their interruption. 8…”

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confidence: 99%

Biologics for psoriasis in COVID ‐19 era: What do we know?

Megna

Napolitano

Patruno

et al. 2020

Dermatologic Therapy

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We have read with great interest the article by Conforti et al who stressed the importance of a therapeutic reassessment of all psoriatic patients, chronically treated with immunosuppressive drugs in the pandemic coronavirus disease (COVID)-19 era. 1 In the context of dermatology, psoriasis patients represent an important subset since their prevalence (125 million worldwide). The literature, mass media, and information campaigns are daily focusing on preventive measures, risk factors, and class of subjects which are at increased risk, in order to

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confidence: 99%

Biologics for psoriasis in COVID ‐19 era: What do we know?

Megna

Napolitano

Patruno

et al. 2020

Dermatologic Therapy

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“…On one hand, it will lead to higher pro-inflammatory states which can potentially worsen the cytokine storm and immune responses to SARS-CoV-2. On the other hand, discontinuation of biological therapies may cause increased medical costs due to the inevitable recurrence of disease, for the efficacy may be reduced if the patient uses the same biological therapy again after discontinuation ( 75 , 76 ). Our study supports the continued use of IL-17 inhibitors in patients with psoriasis during the COVID-19 pandemic, which avoids potential exacerbations of psoriasis due to treatment interruption.…”

Section: Discussionmentioning

confidence: 99%

Risk of COVID-19 infection, hospitalization and mortality in psoriasis patients treated with interleukin-17 inhibitors: A systematic review and meta-analysis

Liu

Wang²,

Liu³

et al. 2022

Front. Immunol.

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BackgroundCoronavirus disease 2019 (COVID-19) have brought great disaster to mankind, and there is currently no globally recognized specific drug or treatment. Severe COVID-19 may trigger a cytokine storm, manifested by increased levels of cytokines including interleukin-17 (IL-17), so a new strategy to treat COVID-19 may be to use existing IL-17 inhibitors, which have demonstrated efficacy, safety and tolerability in the treatment of psoriasis. However, the use of IL-17 inhibitors in patients with psoriasis during the COVID-19 pandemic remains controversial due to reports that IL-17 inhibitors may increase the risk of respiratory tract infections.ObjectivesThe systematic review and meta-analysis aimed to evaluate the effect of IL-17 inhibitors on the risk of COVID-19 infection, hospitalization, and mortality in patients with psoriasis.MethodsDatabases (including Embase, PubMed, SCI-Web of Science, Scopus, CNKI, and the Cochrane Library) were searched up to August 23, 2022, for studies exploring differences in COVID-19 outcomes between psoriasis patients using IL-17 inhibitors and those using non-biologics. Two authors independently extracted data and assessed the risk of bias in a double-blind manner. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and heterogeneities were determined by the Q test and I2 statistic. And the numbers needed to treat (NNTs) were calculated to assess the clinical value of IL-17 inhibitors in preventing SARS-CoV-2 infection and treating COVID-19.ResultsNine observational studies involving 7,106 participants were included. The pooled effect showed no significant differences in the rates of SARS-CoV-2 infection (P = 0.94; I2 = 19.5%), COVID-19 hospitalization (P = 0.64; I2 = 0.0%), and COVID-19 mortality (P = 0.32; I2 = 0.0%) in psoriasis patients using IL-17 inhibitors compared with using non-biologics. Subgroup analyses grouped by age and COVID-19 cases, respectively, revealed consistent results as above. Meanwhile, the pooled NNTs showed no significant differences between the two groups in the clinical value of preventing SARS-CoV-2 infection and treating COVID-19.ConclusionThe use of IL-17 inhibitors in patients with psoriasis does not increase the risk of SARS-CoV-2 infection or worsen the course of COVID-19.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022335195.

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“…It should be noted, however, that in most IBD studies, patients who discontinued anti-TNFs maintained treatment with thiopurines [ 158 ]. On the other hand, only scarce data are available for psoriasis [ 159 ], but 50% of patients will still be in remission 6 months after anti-TNF-α withdrawal, especially those that had a complete response after drug initiation [ 160 ]. Adalimumab tapering is associated with 60% complete skin clearance within a follow-up of at least 4 years [ 161 ].…”

Section: Introductionmentioning

confidence: 99%

The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era

et al. 2022

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Since the late 1990s, tumor necrosis factor alpha (TNF-α) inhibitors (anti-TNFs) have revolutionized the therapy of immune-mediated inflammatory diseases (IMIDs) affecting the gut, joints, skin and eyes. Although the therapeutic armamentarium in IMIDs is being constantly expanded, anti-TNFs remain the cornerstone of their treatment. During the second decade of their application in clinical practice, a large body of additional knowledge has accumulated regarding various aspects of anti-TNF-α therapy, whereas new indications have been added. Recent experimental studies have shown that anti-TNFs exert their beneficial effects not only by restoring aberrant TNF-mediated immune mechanisms, but also by de-activating pathogenic fibroblast-like mesenchymal cells. Real-world data on millions of patients further confirmed the remarkable efficacy of anti-TNFs. It is now clear that anti-TNFs alter the physical course of inflammatory arthritis and inflammatory bowel disease, leading to inhibition of local and systemic bone loss and to a decline in the number of surgeries for disease-related complications, while anti-TNFs improve morbidity and mortality, acting beneficially also on cardiovascular comorbidities. On the other hand, no new safety signals emerged, whereas anti-TNF-α safety in pregnancy and amid the COVID-19 pandemic was confirmed. The use of biosimilars was associated with cost reductions making anti-TNFs more widely available. Moreover, the current implementation of the “treat-to-target” approach and treatment de-escalation strategies of IMIDs were based on anti-TNFs. An intensive search to discover biomarkers to optimize response to anti-TNF-α treatment is currently ongoing. Finally, selective targeting of TNF-α receptors, new forms of anti-TNFs and combinations with other agents, are being tested in clinical trials and will probably expand the spectrum of TNF-α inhibition as a therapeutic strategy for IMIDs.

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Is It Possible to Discontinue Tumor Necrosis Factor Antagonists after Psoriasis Remission?

Cited by 6 publications

References 31 publications

Biologics for psoriasis in COVID ‐19 era: What do we know?

Biologics for psoriasis in COVID ‐19 era: What do we know?

Risk of COVID-19 infection, hospitalization and mortality in psoriasis patients treated with interleukin-17 inhibitors: A systematic review and meta-analysis

The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era

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