COVID ‐19 patients with psoriasis and psoriatic arthritis on biologic immunosuppressant therapy vs apremilast in North Spain

Abstract

Immunosuppressive and immunomodulatory treatments are critical for the management of inflammatory and autoimmune conditions such as psoriasis or psoriatic arthritis. Like in those illnesses, the lung injury and acute respiratory distress shown in COVID‐19 patients are the result of a disruption in the balance of pro‐ and anti‐inflammatory cytokines. This hyperinflammatory response to SARS‐CoV‐2, associated with the severity of the coronavirus disease, is called the cytokine storm. There is a growing concern regarding how patients on immunosuppressant biologic therapies might be at higher risk of being infected and whether they need to discontinue their treatment preemptively. Clinical data on COVID‐19 infected patients with psoriasis or psoriatic arthritis are still scarce. Here, we presented seven cases of this type of patients. The patient infected with COVID‐19 on apremilast and the one on apremilast with infected spouse showed the best safety profile and mildest symptoms. One of the secukinumab patients also presented a relatively good outcome. Infliximab patients and the one with serious comorbidities showed the worst outcome. Even though more clinical data are yet needed to draw strong conclusions, apremilast could be a safer alternative for dermatology and rheumatology patients in case of clinically important active infection. This article is protected by copyright. All rights reserved.

Targeting Neutrophils to Treat Acute Respiratory Distress Syndrome in Coronavirus Disease

“…In particular, cAMP-specific PDE4 type is widely present in immune cells including neutrophils and contributes to neutrophil-mediated lung inflammation ( Baillie et al, 2019 ). There are currently three FDA-approved PDE4 inhibitors: roflumilast for COPD ( Phillips, 2020 ), apremilast for psoriasis ( Queiro Silva et al, 2020 ), and crisaborole for atopic dermatitis ( Hashim et al, 2020 ). Other drugs such as CHF6001 (NCT02986321 for COPD and NCT01689571 for asthma) ( Singh et al, 2019 ), and ensifentrine (RPL554, NCT04027439 for COPD) ( Cazzola et al, 2019 ) are awaiting phase 3 clinical trials.…”

Outcome of COVID-19 in hospitalized patients with chronic inflammatory diseases. A population based national register study in Denmark

“…In recent studies including a meta-analysis, hypertension, diabetes, chronic obstructive pulmonary disease, cardiovascular disease, chronic liver disease, and cerebrovascular disease were independent risk factors associated with the course of COVID-19 [ 4 , 7 , 8 ]. Studies so far, in patients with chronic inflammatory bowel disease (IBD), rheumatoid arthritis (RA), spondyloarthropathy (SpA), and psoriatic arthritis (PsA) have give conflicting results with regard to risk of and outcome of COVID-19, and data regarding medical therapies have suggested an increased risk in patients using glucocorticoids to a reduced risk during treatment with biologics including anti-TNFαagents [ 6 , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] ] [ [21] , [22] , [23] ].…”

Treating multidrug‐resistant psoriasis with brodalumab, apremilast, methotrexate and prednisone combination therapy in the COVID ‐19 pandemic

“…Well tolerated, with mild AEs, and lower risk of immunosuppression and infections, 1,2 apremilast seems to improve efficacy when used in combination with other agents. Moreover, daily practice results in real‐world settings have further reinforce the safety and efficacy of apremilast on psoriasis patients, including those infected with COVID‐19 6,9 …”

“…If psoriasis treatments increase the risk of COVID‐19 infection or cause worse disease prognosis is still a subject of controversy. Some physicians consider that biologic therapies should be suspended, while other argues that this might be a premature decision considering the available evidence 4‐6 . Final decision during the pandemic should be based on well‐informed clinicians and patients, and each case must be weighted individually.…”

“…With no straightforward answer to this question, our case showed that combination therapy with apremilast and other biologic and systemic agents could be a recommendable, effective, and safe choice. Uncontrolled inflammation, loss of response, antibodies formation to the discontinued biologic, 5,6 psychological despair, and increased cost of future therapies are some of the consequences of interrupting the therapy. Therefore, we consider that dermatological treatment should not be abandoned in case of recalcitrant psoriasis, at least that high‐risk COVID‐19‐related factors are at play.…”