key: cord-0731248-n267va7h
authors: Sanchez, Daniela P.; Kirsner, Robert S.; Lev-Tov, Hadar
title: Clinical considerations for managing dermatology patients on systemic immunosuppressive and/or biologic therapy during COVID-19 pandemic
date: 2020-05-04
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.04.143
sha: 4e71da667d102d51bf6536baf99b66b10a0b5ea8
doc_id: 731248
cord_uid: n267va7h

nan

rates associated with biologics were overall comparable to placebo prior to the COVID-19 54 outbreak however, medication and disease specific subtleties exist. For example, anti-TNFs pose 55 a risk for viral infections. However, differing results were seen in treatment of psoriasis versus 56 HS. Secukinumab was associated with increased URI but not the other IL-17 inhibitors. 57

Tofacitinib treatment of psoriatic patients resulted in increase incidence of URI compared to 58 placebo. Cyclosporine is immunosuppressive, however, in management of PG, URI were not 59 reported in a RCT but 11% (N=6) of patients on prednisolone experienced infections requiring 60 hospital admissions compared to none in the cyclosporine arm. Placebo controlled RCTs of other 61 systemic immunosuppressive medications for dermatological indications are lacking. 62

Considering the data presented in this report, the vital protective function of the skin and 63 mucosa, and the relatively lower doses used in dermatology, it is reasonable to conclude that 64 patients with severe dermatological conditions requiring systemic therapies are overall likely to 65 benefit from improved intact cutaneous function afforded by these medications. In high risk 66 patients, consideration of stopping tofacitinib and secukinumab may be warranted. 67

We encourage all patients to focus on infection prevention strategies. If symptoms arise, 68

we advise a stepwise approach (figure 1). 87 

/ 25 (30.1) -Chronic urticaria 41