Assessing Use of Biologic Agents for Psoriasis Amidst COVID-19

A doctor examines psoriasis on patient's elbow
Psoriasis on elbows. Dermatologist and patient
In the absence of COVID-19-specific data, published research may serve to guide treatment with biologic agents in patients with psoriasis.

Existing data on infectious complications arising from biologic agent therapies prescribed to treat patients with psoriasis should drive decision making regarding treatment continuation or cessation amid concerns of the novel coronavirus (COVID-19) infection, according to research from a letter published in the Journal of the American Academy of Dermatology.

The authors compared published data on overall infection rates (including respiratory infections and nasopharyngitis) with different psoriasis treatments vs placebo. Use of tumor necrosis factor blockers increased overall infections and upper respiratory infections by 7% compared with placebo whereas etanercept demonstrated no increase in infection rates. Although no increase in respiratory infection rates was seen in ustekinumab, a small increase in overall infection was noted. A 9% increase in overall infections was shown with use of interleukin (IL)-23 blockers, although reports on their effect on upper respiratory infections were varied.

Treatment of psoriasis with IL-17 blockers showed increases in overall infections by 11%, but the authors allowed that “much of that increase could be accounted for by increases in monilial infections.” Also, no increase in infection was found for ixekizumab or brodalumab although secukinumab demonstrated a small increase for upper respiratory infections.

The study was limited by the small number of infections included and the short placebo-controlled timeframes. Underreporting of minor respiratory infections and infections reported as both upper respiratory in nature or as nasopharyngitis were also cited as study limitations.

“We do not know if biologic therapies render patients more susceptible to coronavirus,” the investigators wrote, adding that “discontinuation of some biologics can result in loss of response when treatments are reintroduced or even result in the formation of antibodies to the discontinued biologic.” Physicians should take these factors into account when counseling patients with psoriasis to continue or discontinue biologic agent therapies, they concluded.

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Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Lebwohl, M, Rivera-Oyola R, Murrell DF. Should biologics for psoriasis be interrupted in the era of COVID-19? [published online March 11, 2020]. J Am Acad Dermatol. doi: 10.1016/j.jaad.2020.03.031