key: cord-1014177-7kevx2uf
authors: Di Lernia, Vito
title: Antipsoriatic treatments during COVID‐19 outbreak
date: 2020-04-10
journal: Dermatol Ther
DOI: 10.1111/dth.13345
sha: f8c79139412b3194aa0affe4c64dde97537417b2
doc_id: 1014177
cord_uid: 7kevx2uf

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ventional or biological antipsoriatic treatments, such as cyclosporine (CsA), methotrexate and tumor necrosis factor (TNF)-alpha blockers.

Indeed, they fear that the immunosuppressive effect of these drugs might increase the risk of infectious complications and promote the spreading of COVID-19 infection in patients with psoriasis.

Although we agree that currently the COVID-19 rate risk in immunosuppressed is largely unknown, we should like to raise a few points.

First, drugs may exert additional effects in addition to their known function. To cite one, the calcineurin inhibitor CsA, affecting the function of many members of the cyclophilin family, is able to block the replication of coronaviruses (CoV) of all genera. 2,3 However, its potential clinical application as anti-CoV therapeutic remains limited by its immunosuppressive effects. 4 Methotrexate, if used in low, noncytotoxic concentrations, is not able to inactivate antigen presentation by dendritic cells. 5 Acute respiratory distress syndrome (ARDS) is the main death cause of COVID-19. 6 Pathophysiology of COVID-19 shows that a In conclusion, there is a complex interplay between viral replication and host immune response also in COVID-19. Because of the absence of cases analyzed, more studies need to evaluate the risk of immunosuppression in patients exposed to COVID-19. Immunosuppressive monotherapy, target therapy, and absence of significant comorbidities could be associated to a lower risk. Presently, a case-bycase assessment seems more appropriate than stopping the ongoing treatments or undertreating the patients with severe psoriasis. 

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

The SARS-coronavirus-host interactome: identification of cyclophilins as target for pan-coronavirus inhibitors

Suppression of coronavirus replication by cyclophilin inhibitors

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Chemotherapeutic agents in noncytotoxic concentrations increase antigen presentation by dendritic cells via an IL-12-dependent mechanism

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On the use of corticosteroids for 2019-nCoV pneumonia