key: cord-0745783-rfkiskda
authors: Holcomb, Zachary E.; Santillan, Monica Rosales; Morss-Walton, Peyton C.; Salian, Prerna; Her, Min Ji; Giannotti, Nicole M.; Kimball, Alexa B.; Porter, Martina L.
title: Risk of COVID-19 in Dermatologic Patients on Long-term Immunomodulatory Therapy
date: 2020-07-02
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.06.999
sha: dc1b43a691c493f8256098f3973c793769309bb2
doc_id: 745783
cord_uid: rfkiskda

nan

As the COVID-19 pandemic has rapidly spread around the globe, concern has been raised regarding susceptibility of patients on immunomodulatory therapies to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. While general guidance has been put forth, data regarding infection rate and outcomes in immunosuppressed patients is still rare. 1 Recent articles, including the work by Gisondi, et al, suggest that outcomes of patients on systemic immunomodulatory therapies infected with SARS-CoV-2 are similar to the general population. 2 These findings may relate to the aberrant cytokine and inflammatory responses in severe COVID-19, which may be treated or partially blunted by cytokine-targeted therapy. 3 Given the substantial outbreak of COVID-19 in our community, we tested whether, in addition to similar outcomes, patients on systemic immunomodulatory therapy had similar infection rates compared to the general population.

We performed a retrospective cross-sectional analysis of patients seen across all providers at Beth Israel Deaconess Department of Dermatology. Our clinical practice has 412 patients on systemic immunomodulatory medications, including biologics and traditional immunosuppressives, prescribed within the past year. Patients were surveyed by either a clinic phone call, telemedicine visit, or through an outreach wellness check-in call from March 15 to May 8, 2020, corresponding to the "peak" incidence of new cases of COVID-19 in Massachusetts.

Of our 412 patients, 327 were successfully contacted, with approximately 80% contacted after April 19, 2020. We were not able to identify any hospitalizations in Boston-area hospitals in the other 85 patients. Results are shown in Table 1 , with age distributions and conditions requiring immunomodulatory therapy displayed in Figure 1 . There were no statistical differences between age, gender, or medications between the patients who were reached and those who were not.

As one of the "hotspots" of viral spread in the United States, Boston and the surrounding areas are ideal locations for studying effects of viral transmission. At the time of data collection, slightly over 1% of Massachusetts residents had been diagnosed with COVID-19, and slightly fewer than 10% of cases required hospitalization. 4 These numbers were similar in our patient population, with only five infections and one hospitalization, suggesting that the risk of both COVID-19 and poor outcomes are minimally impacted by dermatologic immunomodulatory medications. However, it is worth noting that many patients were successfully isolating to a large degree, and the low infectious rates appear to be due, at least in part, to enhanced "social distancing" efforts. As has been proposed previously 5 , our finding suggest that when combined with patient education and encouragement to minimize exposure risks, systemic immunomodulatory therapies for dermatologic indications can be safely continued during the COVID-19 pandemic.

Limitations include the unknown number of possible asymptomatic infections, lack of available confirmatory COVID-19 testing in some cases, and the impact of social distancing as a confounding factor on infection rates. Also, our practice consists of only adult patients. Despite these limitations, we did not see evidence of increased infectious risk and we hope that these data will inform treatment decisions for patients who need these medications despite the ongoing COVID-19 pandemic. 

*Other diagnoses included bullous pemphigoid (6), pyoderma gangrenosum (4), alopecia areata (2), lichen planopilaris (2), unspecified pruritus (2), vasculitis (2), acne keloidalis nuchae (1), discoid lupus erythematosus (1), granuloma annulare (1) 

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