key: cord-0882638-w71zqqv7
authors: Megna, M.; Napolitano, M.; Patruno, C.; Fabbrocini, G.
title: Biologics for psoriasis in COVID‐19 era: what do we know?
date: 2020-04-27
journal: Dermatol Ther
DOI: 10.1111/dth.13467
sha: 9f8ae2031772007c7b69420127324ba7c09e7a61
doc_id: 882638
cord_uid: w71zqqv7

nan

Dear Editor, we have read with great interest the article by Conforti et al. who stressed the importance of a therapeutic reassessment of all psoriatic patients, chronically treated with immunosuppressive drugs in the pandemic coronavirus disease (COVID)-19 era. 1 In the context of Dermatology, psoriasis patients represent an important subset since their prevalence (125 million worldwide).

Literature, mass media and information campaigns are daily focusing on preventive measures, risk factors and class of subjects which are at increased risk, in order to sensitize the general population, and limit behaviors which could facilitate virus diffusion. We agree that whether stopping or not these treatments in psoriasis patients represents a hot and unsolved topic which needs to be further Accepted Article manifested by increase of Th17 and high cytotoxicity of CD8 T cells, accounted for a severe immune injury in their COVID-19 case report, also highlighting that the pathological features of COVID-19 greatly resemble those seen in Severe Acute Respiratory Syndrome (SARS) and Middle Eastern respiratory syndrome (MERS) coronavirus infection. 4 Indeed, it has been reported that IL-17 commonly produced during SARS specifically augments a pro-inflammatory response by directly synergizing with antiviral signaling, thus exerting excessive inflammation which is destructive for the lungs. 5 Moreover, examining all possible therapeutic targets for COVID-19 in their recent article on Lancet, Zumla et al. also hypothesize that blocking IL-17 could have the potential to improve COVID-19's aberrant immune response and acute respiratory distress syndrome-related mortality. 6 Indeed, a Chinese clinical trial evaluating an anti-IL17 drug approved for psoriasis and psoriatic arthritis, ixekizumab, is already running. 7 Therefore, since definitive evidences that biologics blocking TNF-α and anti-IL17 increase the risk of COVID-19 is lacking, we believe that preventive treatment discontinuation should be avoided and reserved to COVID-19 patients, subjects with active symptoms or who have had a contact to a confirmed COVID-19 patient. Indeed, unnecessary biologic discontinuation would lead to a worsening of psoriasis and psoriatic arthritis in a high percentage of the cases. As a consequence, there may be higher disease burden, destructive impact on quality of life, as well as increased health care costs due to the augmented number of consultations and recovery. Furthermore, the unavoidable subsequent return to biologic therapy could be associated with switching toward higher cost drugs, due to the wellknown lower efficacy of biologics in the same patient after their interruption. 8

COVID-19 and psoriasis: is it time to limit treatment with immunosuppressants? A call for action

Coronavirus infections and immune responses

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Pathological findings of COVID-19 associated with acute respiratory distress syndrome

IL-17 boosts proinflammatory outcome of antiviral response in human cells