key: cord-0988328-0z2payka
authors: Georgakopoulos, Jorge R.; Mufti, Asfandyar; Vender, Ron; Yeung, Jensen
title: Treatment discontinuation and rate of disease transmission in psoriasis patients on biologic therapy during the COVID-19 pandemic – A Canadian Multicenter Retrospective Study
date: 2020-07-15
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.07.021
sha: cb3b412226e38a71def51a6d8a48bd90befc7173
doc_id: 988328
cord_uid: 0z2payka

nan

At this time, limited data is available to guide use of biologics for moderate-to-severe plaque psoriasis in the current coronavirus disease 2019 (COVID-19) healthcare landscape. 1, 2 We aimed to further understand the rate of patient driven biologic discontinuation in moderate to severe psoriasis due to concerns regarding COVID-19 complications. Furthermore, our goal was to add to the limited but growing literature on whether biologic use should be considered a risk factor for greater susceptibility to COVID-19.

Following research ethics approval, a multicenter retrospective study was undertaken of all patients from two tertiary academic hospitals affiliated with the University of Toronto, Canada and a community practice in Hamilton, Canada. Inclusion criteria were patients 18 years of age or older with moderate to severe psoriasis who received at least one dose of a biologic prior to February 1, 2020. Data was retrospectively obtained from Patient Support Program (PSP) Case Managers of all major suppliers of biologic agents for psoriasis. February 1 st , 2020 was the starting point of data collection (5 documented COVID-19 cases and 0 deaths in Canada) and patients were followed up until June 1 st , 2020 (91703 cumulative cases and 7594 deaths). 3 As of February 1 st , 2020, there were 2095 patients on biologic therapy for psoriasis who met inclusion criteria. Total number of patients who temporarily discontinued their biologic at any point during the 4month period due to COVID-19 related concerns was 23 (1.1%) ( Table 1) . Of the 23 patients who temporarily discontinued their biologic, 7 were in the month of February, 11 in March, 3 in April, and 2 in May. This corresponded to a total of 17 (0.81%), 18 (0.86%) and 18 (0.86%) patients off treatment at each April 1, May 1 and June 1, 2020 timepoints, respectively. Biologic discontinuation by class included: TNF-α inhibitors (8/749, 1.07%), interleukin-12/23 inhibitor (5/371, 1.35%), interleukin-17 inhibitors (4/482, 0.83%) and interleukin-23 inhibitors (6/493, 1.22%) ( Table 2 ). Mean duration of biologic treatment prior to discontinuation was 50.6 ± 35.7 months. Five patients who temporarily discontinued their biologic elected to restart on the same biologic prior to June 1, compared to 18 who remained off treatment. All patients who restarted their biologic (5/5, 100%) did so due to a flare of their psoriasis. Of the 23 patients who temporarily discontinued treatment, 14 (60.9%) were male, mean age was 56.4 ± 12.6 years and 1 (4.3%) patient also had psoriatic arthritis. Of the 2095 patients in our cohort (2072 [98.9%] of which remained on a biologic throughout the entire follow-up period), 0 (0%) had a confirmed positive diagnosis of COVID-19. Importantly, all patients who developed COVID-19 related symptoms received testing and tested negative. Of the 16 new biologic treatment starts between April 1 and June 1, 2020, the majority were interleukin-17 inhibitors (n=13, 81.2%), followed by TNF-α inhibitors (n=2, 12.5%) and interleukin-23 inhibitors (n=1, 6.2%).

The results of this study demonstrate that the rate of patient driven biologic discontinuation during the peak of COVID-19 cases in Canada remained low across the entire 4-month follow-up period. Although interleukin-17 inhibitors had the lowest rate of temporary discontinuation, there did not appear to be a major class specific difference in rates. Our findings provide some of the earliest evidence supporting current COVID-19 biologic treatment guidelines and encourage continuation of biologics in asymptomatic COVID-19 negative patients despite the risk of future outbreaks. 4,5 Discontinuation of treatment out of concerns for contracting COVID-19 is not supported as it may lead to decreased efficacy outcomes with re-introduction or a flare of psoriasis as seen with our cohort. Low volumes of new biologic starts highlights the need for improved access to non-urgent care during the pandemic. Table 1 . Demographics of psoriasis patients who temporarily discontinued biologic treatment due to COVID-19 Total number of patients on a biologic for psoriasis as of February 1, 2020 and followed throughout the entire 4-month study period. b Total number of patients who discontinued their biologic including those who restarted prior to June 1.

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