Safety of conventional immunosuppressive therapies for patients with dermatological conditions and coronavirus disease 2019: A review of current evidence

Abstract

The effect of coronavirus disease 2019 (COVID‐19) on patients receiving conventional immunosuppressive (IS) therapy has yet to be fully determined; however, research on using IS therapy for treating COVID‐19 in acutely ill patients is increasing. While some believe that IS therapy may be protective, others argue that these agents may make patients more susceptible to COVID‐19 infection and morbidity and advocate for a more cautious, individualized approach to determining continuation, reduction, or discontinuation of therapy. In this review, we aim to provide an overview of COVID‐19 risk in dermatological patients who are receiving conventional IS therapies, including mycophenolate mofetil, methotrexate, cyclosporine, azathioprine, apremilast, JAK inhibitors, and systemic steroids. Additionally, we provide recommendations for management of these medications for dermatological patients during the COVID‐19 pandemic. Treatment of dermatological disease during the COVID‐19 pandemic should involve shared decision‐making between the patient and provider, with consideration of each patient’s comorbidities and the severity of the patient’s dermatological disease.

DHFR Inhibitors Display a Pleiotropic Anti-viral Activity Against SARS-CoV-2: Insights Into the Mechanisms of Action

“…First clinical evidence on the potential beneficial effects of the treatment with a DHFR inhibitor in COVID-19 disease was observed in patient receiving MTX for treating psoriasis or rheumatoid arthritis [53][54][55][56][57][58][59]. These studies suggested that MTX treatment did not worsen COVID-19 outcomes and rates of hospitalization in these patients, probably acting on inflammation associated to SARS-CoV-2 infection [60][61][62]; however, as the cohort of patients was heterogeneous in terms of period of MTX treatments and clinical manifestations of COVID-19, no clear conclusion on the benefits of MTX therapies could be extrapolated.…”

DHFR Inhibitors Display a Pleiotropic Anti-Viral Activity against SARS-CoV-2: Insights into the Mechanisms of Action

“…The first clinical evidence of the potential beneficial effects of the treatment with a DHFR inhibitor in the COVID-19 disease was observed in patients receiving MTX for treating psoriasis or rheumatoid arthritis [ 59 , 60 , 61 , 62 , 63 , 64 , 65 ]. These studies suggested that MTX treatment did not worsen COVID-19 outcomes or rates of hospitalization in these patients, probably due to effects on inflammation associated with the SARS-CoV-2 infection [ 66 , 67 , 68 ]; however, as this cohort of patients was heterogeneous in terms of the period of MTX treatments and clinical manifestations of COVID-19, no clear conclusion on the benefits of MTX therapies could be extrapolated.…”

Significant Responses of Skin Conditions or Other Disorder after COVID-19 Vaccine

“…These recommendations are based on currently available data. However, the COVID-19 pandemic continues to change rapidly and these recommendations may change as more data becomes available (Arora et al, 2021). In addition, safety monitoring is the core of vaccine performance monitoring.…”