Should SARS‐CoV‐2 influence immunosuppressive therapy for autoimmune blistering diseases?

Altobrando, Ambra Di; Patrizi, Annalisa; Bardazzi, Federico

doi:10.1111/jdv.16491

Cited by 24 publications

(23 citation statements)

References 5 publications

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“…• Virus could act as target mimicry in immunobullous disorders and may trigger or aggravate disease course but it is not recommended to do not treat properly, since poor disease control have its own consequences; even probable more severe and complicated COVID-19 infection; due to deregulated inflammatory storms. 61,[81][82][83] • If possible, postpone rituximab infusions temporarily in management of pemphigus, especially in the case of time approximation regarding peak of drug immunosuppression and peak of society COVID-19 burden.…”

Section: Immunobullous Disordersmentioning

confidence: 99%

Cutaneous manifestations and considerations in COVID ‐19 pandemic: A systematic review

Seirafianpour

Sodagar

Mohammad

et al. 2020

Dermatologic Therapy

117

136

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Background COVID‐19 had a great impact on medical approaches among dermatologist Objective This systematic review focuses on all skin problems related to COVID‐19, including primary and secondary COVID‐related cutaneous presentations and the experts recommendations about dermatological managements especially immunomodulators usage issues Method Search was performed on PubMed, Scopus, Embase and ScienceDirect. Other additional resources were searched included Cochrane, WHO, Medscape and coronavirus dermatology resource of Nottingham university. The search completed on May/03/2020. 377 articles assigned to the inclusion and exclusion groups Result Eighty‐nine articles entered the review. Primary mucocutaneous and appendageal presentations could be the initial or evolving signs of COVID‐19. It could be manifest most commonly as a maculopapular exanthamatous or morbiliform eruption, generalized urticaria or pseudo chilblains recognized as “COVID toes” (pernio‐like acral lesions or vasculopathic rashes). Conclusion: During pandemic, Non‐infected non‐at risk patients with immune‐medicated dermatologic disorders under treatment with immunosuppressive immunomodulators are not needed to alter their regimen or discontinue the therapies. At‐risk and infection‐suspected patients needed to dose reduction, interval increase or temporary drug discontinuation (at least 2 weeks). Patients with an active COVID‐19 infection should hold the biologic or non‐biologic immunosuppressives until the complete recovery occur (at least 4 weeks). This article is protected by copyright. All rights reserved.

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Section: Immunobullous Disordersmentioning

confidence: 99%

Cutaneous manifestations and considerations in COVID ‐19 pandemic: A systematic review

Seirafianpour

Sodagar

Mohammad

et al. 2020

Dermatologic Therapy

117

136

View full text Add to dashboard Cite

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“…12,13 In another study conducted in Italy, the authors interviewed 83 patients (30 males, 53 females; average age 58.6 years) with the autoimmune bullous diseases. 14 The guideline provided by the European Academy of Dermatology and Venereology Task Force Autoimmune Blistering Diseases recommended not to stop or reduce ongoing treatment unless there is a particular reason. The guideline suggested to discuss reducing the dose of systemic corticosteroids for COVID-19 positive patients.…”

Section: Pemphigus Diagnosis In the Era Of Covid-19 Pandemicmentioning

confidence: 99%

Pemphigus and COVID ‐19: Critical overview of management with a focus on treatment choice

Elmas

Demirbaş

Türsen

et al. 2020

Dermatologic Therapy

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COVID-19 is a serious multisystem disease caused by severe acute respiratory syndrome coronavirus 2. Due to the COVID-19 crisis, that still keeps its impacts worldwide, numerous scheduled medical activities have been postponed and this interruption has a potential to modify the management of many cutaneous conditions including pemphigus. This narrative review aims to discuss the management of pemphigus in the era of COVID-19, considering the necessity to balance suitable pemphigus treatment with minimal risk of COVID-19-related mortality and morbidity. The data on the effect of treatments used for pemphigus on COVID-19 are limited. However, the evidence to manage patients properly is evolving and our knowledge is updated. Current expert recommendations include that patients with pemphigus should be informed clearly to avoid mismanagement and they should be monitored regularly for symptoms of COVID-19. Patients with mild disease can be managed with topical or intralesional corticosteroids, dapsone, or doxycycline. Systemic corticosteroids should be tapered to the lowest effective dose during the pandemic. Prednis(ol)one ≤10 mg/d can be continued in patients with COVID-19 while prednis(ol)one >10 mg/d may be reduced considering the activity of the disease. Conventional immunosuppressive therapies should only be discontinued in confirmed cases of COVID-19. Postponing rituximab treatment should be considered on a case by case basis. Intravenous immunoglobulin is not likely to increase the risk of infection and may be considered a safe option in patients with COVID-19. Given the psychological burden brought by COVID 19, online or face-to-face psychological support programs should be considered.

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“…8,9 To date, there is neither an agreement nor a study sustaining the impact of continuing or stopping biologics in psoriatic patients during the COVID-19 pandemic. [10][11][12][13][14][15][16] Furthermore, data on the epidemiology of COVID-19 disease in patients treated with biological drugs are very scarce. 8 A C…”

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confidence: 99%

Characteristic of chronic plaque psoriasis patients treated with biologics in Italy during the COVID-19 Pandemic: Risk analysis from the PSO-BIO-COVID observational study

Talamonti

Galluzzo

Chiricozzi

et al. 2021

Expert Opinion on Biological Therapy

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Background The susceptibility of patients with chronic plaque psoriasis and the risks or benefits related to the use of biological therapies for COVID-19 are unknown. Few data about prevalence, clinical course and outcomes of COVID-19 among psoriatic patients were reported. The aims of this study were 1) to assess the prevalence and severity of COVID-19 in psoriatic patients treated with biologic agents during the first phase of the emergency (22 February to 22 April 2020) in Italy, and 2) to report the clinical outcomes of patients who have been exposed to individuals with confirmed SARS-CoV-2 infection. Methods Patients with moderate-to-severe chronic plaque psoriasis, aged ≥18 years and undergoing treatment with biologic agents as of 22 February 2020, were eligible to be included in PSO-BIO-COVID study. Demographic and clinical characteristics of patients using any biologic for psoriasis treatment between 22 February and 22 April 2020 were registered. For all confirmed or suspected cases of COVID-19, data about concomitant disease, ongoing therapies, and comorbidities were also reported. Results A total of 12,807 psoriatic patients were included in the PSO-BIO-COVID study. In this cohort twenty-six patients (0.2%) had a swab confirmation of SARS-CoV-2 infection. Eleven patients required hospitalization and two died. 125 of 12807 patients (1.0%) with exposure to a patient with COVID-19 under quarantine or active health surveillance, were reported. Conclusion The incidence of COVID-19 observed in our cohort of psoriatic patients (0.2%) is similar to that seen in the general population (0.31%) in Italy. However, the course of the disease was mild in most patients. Biological therapies may likely lessen "cytokine storm" of COVID-19, which sometimes lead to multiple organ failure, ARDS, and death.

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Should SARS‐CoV‐2 influence immunosuppressive therapy for autoimmune blistering diseases?

Cited by 24 publications

References 5 publications

Cutaneous manifestations and considerations in COVID ‐19 pandemic: A systematic review

Cutaneous manifestations and considerations in COVID ‐19 pandemic: A systematic review

Pemphigus and COVID ‐19: Critical overview of management with a focus on treatment choice

Characteristic of chronic plaque psoriasis patients treated with biologics in Italy during the COVID-19 Pandemic: Risk analysis from the PSO-BIO-COVID observational study

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