The Impact of Immune-Modulating Treatments for Dermatological Diseases on the Risk of Infection with SARS-CoV-2 and Outcomes Associated with COVID-19 Illness

Abstract

Purpose of Review Immune-modulating treatments are used in dermatology for a variety of conditions. The authors aim to review the data regarding the safety of these treatments during the COVID-19 pandemic, namely the risk of infection with SARS-CoV-2 and the outcomes associated with COVID-19-related illness. Recent Findings Several large-scale studies found no increased risk of COVID-19 infection for patients on TNF-α inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, IL-23 inhibitors, dupilumab, and methotrexate. They also found that these patients did not have worse outcomes when infected with COVID-19. The data regarding JAK inhibitors, rituximab, prednisone, cyclosporine, mycophenolate mofetil, and azathioprine are more mixed. Summary Based on current research and guidelines from the American Academy of Dermatology and the National Psoriasis Foundation, dermatology patients on immune-modulating therapies can continue treatment during the COVID-19 pandemic when they are not infected with SARS-CoV-2. For patients who have COVID-19, guidelines encourage individualized assessment of the benefits and risks of continuing or temporarily withholding treatment.

The inflammatory microenvironment of the lung at the time of infection governs innate control of SARS-CoV-2 replication

“…We found that the pro-inflammatory TNFR1 pathway is critical for early viral control of SCV2 replication in mice and that pulmonary preconditioning with recombinant TNFα potently limits SCV2 viral titers in the lung. Of note, patients undergoing TNFα blockade as a long-term treatment for dermatological or rheumatic diseases showed no increase in hospitalizations or severe COVID-19 disease [107][108][109] . However, the impact on early control of viral replication is difficult to ascertain from such clinical studies.…”