key: cord-0795170-xut4z1kw
authors: Kow, Chia Siang; Hasan, Syed Shahzad
title: The optimal time to the resumption of biologics after COVID-19
date: 2020-09-24
journal: JAAD international
DOI: 10.1016/j.jdin.2020.09.003
sha: b1535c901c28316c67902337b5b151f9b176eaf0
doc_id: 795170
cord_uid: xut4z1kw

nan

We agree with Lee et al. [1] who called on constant modification of guidelines about biologics use in dermatologic diseases amid novel coronavirus disease 2019 (COVID-19) pandemic based on emerging evidence. In fact, the authors' effort to summarize different expert's opinions or official statements from various professional dermatological organizations for the recommendation on biologics use in dermatologic patients amid COVID-19 pandemic should be complimented since it has facilitated the reference for dermatologists and pharmacists.

We too agree with authors that there are very limited data to inform the optimal time to the resumption of biologics in patients with confirmed COVID-19, in which such research gap may create a dilemma for dermatologists in the era of COVID-19. Without conclusive data as yet, there should be no one size fits all approach to the time to the resumption of biologics, and the decision should be individualized, preferably based on the severity of illness. However, it should be reasonable to resume biologics when patients are no longer symptomatic with at least two weeks have passed since documented COVID-19 based on the following observations. Isolation of live or viable severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is replication-competent, has not been possible after 9 days of symptom onset in patients with a mildto-moderate course of illness of COVID-19. To illustrate, in a small observational study [2] of nine COVID-19 patients, viral loads progressively decreased, and the live virus was unable to be isolated after eight days following symptom onset. Similarly, a cross-sectional study [3] that investigated ninety positive samples of SARS-CoV-2 ranged from the day of symptom onset (Day 0) up to 21 days after symptom onset reported that positive cultures were observed only up to 8 days following symptom onset. In addition, Arons et al. [4] reported their findings from thirty-one COVID-19 patients that the isolation of viable virus from nasopharyngeal and oropharyngeal swabs was only possible up to 9 days following symptom onset.

Isolation of live or viable virus between 10 and 20 days after symptom onset has been reported in certain COVID-19 patients with a severe course of illness complicated by immunocompromised state.

In a series of 129 COVID-19 patients who had a severe or critical course of illness of which 30 of them were immunocompromised, viable virus was recovered from a single patient up to 20 days after symptom onset [5] . However, it was also observed that 95% of the samples no longer yielded a replication-competent virus 15 days post symptom onset [5] .

We shall await more data from large-scale studies, preferably with different variants of SARS-CoV-2, to better inform the evidence. In the meantime, resumption of biologics could be considered two J o u r n a l P r e -p r o o f

Use of Biologics in the Era of COVID-19: Where Do We Stand?

Virological assessment of hospitalized patients with COVID-2019

Predicting infectious SARS-CoV-2 from diagnostic samples

Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility

Shedding of infectious virus in hospitalized patients with coronavirus disease-2019 (COVID-19): duration and key determinants