Anti-inflammatory, immunomodulatory agents influence the way the immune system reacts. Are psoriasis patients at increased risk for coronavirus infection while receiving system therapy? What to consider?
In a statement, Professor Dr. Dr. Alexander Navarini, chief physician and board member of the Swiss Psoriasis and Vitiligo Society (SPVG) summarizes the current consensus recommendations for psoriasis patients under system therapy as follows [1]: Based on guidelines of the FOPH, according to which patients over 65 years and/or with a previous disease belong to a risk group, the risk is also classified as increased for psoriatic patients. In principle, patients should be continued on systemic therapy, but it must be weighed on a case-by-case basis. “We don’t have a consensus for the individual drugs, except for the following biologics: IL-17, IL-23, and 12/23 antagonists; we pass on all of these,” Prof. Navarini explained. However, in cases of confirmed COVID-19 infection, immunosuppressants should be discontinued.
Dr. Ralph von Kiedrowski, a member of the board of the Professional Association of German Dermatologists, points out that little is yet known about the consequences of SARS-CoV-2 infection [2]. For psoriasis patients who are otherwise healthy, the same hygiene and precautionary measures apply as for everyone. For psoriatics who have not yet been vaccinated against influenza and pneumococcus, this additional preventive measure can still be recommended now, Dr. Kiedrowski said. Whether psoriasis system therapy should be discontinued prophylactically depends on the individual’s health status and the active ingredients, he said. In patients who have also experienced more frequent infections and/or have additional lung disease while on immunotherapy, a pause in therapy may be considered. According to current data, TNF-alpha antagonists have a higher risk of infection than IL17 and IL23 inhibitors or PDE4 inhibitors. “Substances such as IL12/23 or MTX also more frequently show protracted courses of infection in clinical practice; in the case of MTX, it should also be borne in mind that the substance can have a lung-damaging effect in rare exceptional cases,” adds Dr. Kiedrowski. At the first symptoms of a coronavirus infection, patients should first clarify whether the suspicion of a coronavirus infection is well-founded and contact (by telephone) their family doctor and possibly also the dermatologist treating them. “Until the suspicion is clarified, psoriasis system therapy should be paused,” the expert said.
Literature:
- Swiss Psoriasis and Vitiligo Society (SPVG): Statement of the Swiss Psoriasis Experts (as of March 24, 2020), www.spvg.ch
- Professional Association of German Dermatologists (BVDD): Corona risks in psoriasis: no reason to panic even under system therapy (17.03.2020), www.bvdd.de
DERMATOLOGIE PRAXIS 2020; 30(2): 5 (published 4/24/20, ahead of print).
