11
views
0
recommends
+1 Recommend
2 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Letter to the editor regarding article “Yalici‐Armagan B, Tabak GH, Dogan‐Gunaydin S, Gulseren D, Akdogan N, Atakan N. Treatment of psoriasis with biologics in the early COVID‐19 pandemic: A study examining patient attitudes toward the treatment and disease course. J Cosmet Dermatol. 2021;00:1–5”

      letter

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          CONFLICT OF INTEREST None. ETHICAL APPROVAL The authors confirm that the ethical policies of the journal, as noted on the journal’s author guidelines page, have been adhered to. No ethical approval was required as this is a review article with no original research data. AUTHOR CONTRIBUTIONS Luca Potestio involved in data curation, formal analysis, investigation, visualization, and writing‐original draft preparation. Elisa Camela involved in data curation, investigation, methodology, visualization, and writing‐original draft preparation. Gabriella Fabbrocini involved in conceptualization, validation, visualization, and writing—review and editing, supervision. Matteo Megna involved in conceptualization, validation, visualization, writing‐original draft preparation, and writing—review and editing. All authors read and approved the final version of the manuscript. Dear Editor, We read with great interest the article published by Yalici‐Armagan et al. 1 titled “Treatment of psoriasis with biologics in the early COVID‐19 pandemic: A study examining patient attitudes toward the treatment and disease course” reporting that 30 out of 106 patients (28.3%) autonomously discontinued biologic therapy for psoriasis during COVID‐19 pandemic, frequently experiencing disease worsening (20/30, 66.7%). Herein, we describe our experience at the Dermatology Centre of the University of Naples Federico II, reporting that only 16/965 psoriasis patients (1.6%) stopped the biologic treatment during the early pandemic period (February 2020–June 2020). 2 Among these, 13/16 (81.3%) voluntarily interrupted biologic therapy and the remaining (3/16, 18.8%) after seeking medical advice. Similarly, 7/965 subjects (7.3%) voluntarily delayed the biologic administration. Detailed features of Yalici‐Armagan et al. study population and ours are reported and compared in Table 1. Student's t test (for continuous variables) and Chi‐square test (for categorical variables) were used to calculate statistical differences. P‐values <0.05 were considered to be statistically significant. All statistical analyses were performed using GraphPad Prism 4.0 (GraphPad Software Inc., La Jolla, CA, USA). TABLE 1 Comparison between Yalici‐Armagan et al.’s population and our sample. Our study (n=965) Yalici‐Armagan et al. (n = 106) P Time of observation February 2020–June 2020 March 2020–July 2020 Demographic features State Italy Turkey Sex, M (%) 565 (58.5) 65 (61.3) ns Mean age (years) 52.5 46.1 N/A Mean disease duration (years) – 18 N/A Current biologic treatment n (%) Anti ‐TNF Adalimumab 238 (24.7) 4 (3.7) <0.001 Etanercept 72 (7.5) 1 (0.9) <0.05 Infliximab 1 (0.1) 19 (17.9) <0.001 Anti‐IL12/23 Ustekinumab 244 (25.3) 48 (45.2) <0.01 Anti‐IL23 Guselkumab 51(5.3) 0 (0) <0.001 Risankizumab 13 (1.3) 0 (0) ns Tildrakizumab 0 (0) 0 (0) ns Anti‐IL17 Brodalumab 5 (0.5) 0 (0) ns Ixekizumab 189 (19.6) 4 (3.7) <0.001 Secukinumab 152 (15.7) 30 (28.3) <0.05 Treatment compliance n (%) Continuation 942 (97.6) 76 (71.7) <0.05 Temporary suspension 7 (0.7) 0 (0) ns Voluntarily 5 (0.5) 0 (0) ns After medical advice 2 (0.2) 0 (0) ns Interruption 16 (1.6) 30 (28.3) <0.001 Voluntarily 13 (1.3) 30 (28.3) <0.001 After medical advice 3 (0.3) 0 (0) ns Patients with COVID‐19 infection n (%) 1 (0.1) 0 (0) ns John Wiley & Sons, Ltd Our investigated sample is significantly greater than Yalici‐Armagan et al., 1 being comparable for sex and mean age. However, a significant lower discontinuation rate of biologics was assessed in our cohort compared with Yalici‐Armagan et al. (1.6% vs 28.3) ones. Several factors may explain this result: the difference in COVID‐19 incidence rate between Italy and Turkey and different related government actions, the necessity of hospitalization for intravenous administration of infliximab, a drug which was more frequently used in the Turkish sample, different subjects’ attitudes to psoriasis and their treatments, as well as the telemedicine and informatic support system developed by our clinic during the pandemic. Indeed, at our Institution psoriasis patients were daily contacted by phone and/or e‐mails in order to provide them updated information about the relationship of COVID‐19, psoriasis, and biologics, and to answer their questions and fears. 3 In this way, we could reassure the patients about the safety of biologics even during pandemic, avoiding the spread of fake news and increasing patients’ compliance, limiting biologic interruption only when necessary (eg, respiratory symptoms, fever, strict contact to a confirmed COVID‐19 case, etc.). We believe that our telemedicine reorganization system was strictly necessary to avoid uncontrolled discontinuation of biologics which would have led to significant disease worsening, decreased quality of life, and increased health costs. 4 In literature, there are different studies investigating the use of biologics during pandemic and the relationship with COVID‐19 infection. 5 Regarding psoriatic disease, drugs selectively blocking tumor necrosis factor (TNF) and interleukins (IL) 23, 17, and 12/23 have revolutionized the management of this disease. Among these cytokines, TNF and IL17 inhibition seem to prevent the infection of SARS‐CoV‐2 and the cytokine storm of COVID‐19 while the possible role of IL23 in the pathogenesis of COVID‐19 infection is not understood yet. 5  The initial doubts about the use of biologics at the beginning of COVID‐19 pandemic have been soon clarified in literature. Indeed, nevertheless Conforti et al. 6 expressed the fear of an increased infection risk and more severe disease course advising to preventively discontinue biologics, several studies have confirmed the safety of these drugs even during the pandemic. 5 Suggesting patients to discontinue biologic treatment for psoriasis in order to reduce the risk of COVID‐19 infection is absolutely not advisable since it would worsen the disease and its psychological impact as well as it would cause a higher pro‐inflammatory state which may potentially increase the susceptibility to a more severe SARS‐CoV2 condition. In conclusion, clinicians should guide and continuously assist psoriasis patients in order to reduce incorrect autonomous decisions and allow to reach the best therapeutic outcomes informing them regarding the more recent evidence about psoriasis, COVID‐19, and COVID‐19 vaccines.

          Related collections

          Most cited references6

          • Record: found
          • Abstract: found
          • Article: found

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

          Dear Editor, The recent outbreak of coronavirus disease 19 (COVID‐19), caused by the virus SARS‐CoV‐2, led to a series of containment and preventive measures to limit its spread. Most cases involve patients aged 30 to 80 years with low mortality in healthy individuals where the infection may have an asymptomatic/paucisymptomatic course, recovering from the disease without any special treatment. About one of the six people with COVID‐19 become seriously ill, developing life‐threatening breathing difficulties with a mortality rate of about 2%.1 The elderly and subjects with preexisting diseases (diabetes, cardiovascular disease, and cancer) are the most susceptible and may develop severe respiratory syndrome coronavirus.1 Currently, the COVID‐19 rate risk in immunosuppressed is still largely unknown. In the past, cases of epidemic severe influenza viral infections have been described: Serrato et al reported a case of swine influenza A (H1N1) infection in a psoriatic patient on adalimumab.2 Furthermore, Kling et al described a patient with psoriasis taking immunosuppressive drugs resulted positive for influenza A (H1N1) who, after an initially efalizumab therapy, was switched to infliximab for a severe psoriatic flare and died after her first infusion.3 Based on previous cases of death or increased risk of infection from viral diseases in immunosuppressive patients, we would like to stress the importance of a therapeutic reassessment of all psoriatic patients, chronically treated with immunosuppressive drugs, that weaken the immune system and make them more susceptible to opportunistic infections. Cyclosporine (CsA), methotrexate (MTX) and anti‐TNF‐alpha are among the first‐choice therapies for psoriatic patients with PASI>10, often prescribed to healthy young patients free from cardiovascular diseases and comorbidities.4 Given the increased risk of opportunistic infections, we wonder whether this is the most appropriate time to start immunosuppressive therapy in patients with psoriasis. On the one hand, we must consider that in patients with erythrodermic psoriasis or severe psoriatic arthritis immunosuppressive treatments are essential; on the other hand, we must not overlook the immunosuppressive effect of these drugs, which can presently increase the risk of infectious complications and promote the spreading of COVID‐19 infection. Although the rapid effect of these drugs is well demonstrated, it should be considered that the psoriatic patients on CsA/MTX/anti‐TNF‐ɑ are partly immunodepressed with an increased risk of opportunistic infections and to date it is unknown whether there may be an increased risk of COVID‐19 infection in these patients. Obviously, all patients should practice good hygiene and other measures to protect against infections. While waiting for official and specific data concerning the risk of COVID‐19 infection in patients treated with immunosuppressive drugs, we suggest that in areas of high infection rate or outbreaks the treatment with CsA/MTX/anti‐TNF‐ɑ should be carefully weighted because these drugs may cause decreased immune response and greater susceptibility to life‐threatening infections; in this way it is extremely important to limit and/or reduce the time of administration, preferring topical and/or drugs with a lower impact on the immune system until certain data; we also suggest to stop all immunosuppressive and biological therapy where exposure to confirmed COVID‐19 occurs, as recommended for other previous outbreaks.5 CONFLICT OF INTEREST The authors declare no potential conflict of interest.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found

            Face the COVID‐19 emergency: measures applied in an Italian Dermatologic Clinic

            Abstract We have read with great interest the article by Radi et al. which reported the measures applied in order to limit the spread of coronavirus‐infection in their dermatological clinic. Particularly they described all the exceptional precautionary measures adopted in order to face COVID‐19‐emergency and to reduce the spread of infection. Herein we report the experience of our dermatologic Clinic (University of Naples Federico II) which has a very large catchment area and a high number of annually visits (59000 visits in the 2019).
              Bookmark
              • Record: found
              • Abstract: found
              • Article: found

              Biologic Therapies, Psoriasis, and COVID-19: Our Experience at the Psoriasis Unit of the University of Naples Federico II

              Dear Editor, Since the worldwide spread of SARS-CoV-2 infection, great concern arose on the safety of biologics, whose role has been extensively discussed on whether being beneficial, neutral, or detrimental in terms of susceptibility to the infection and/or severity of COVID-19 disease [1]. Biologics generally expose patients to an increased risk of contracting common and opportunistic infections; conversely, some classes of biologics, i.e. anti-interleukin (IL)-6 receptor, anti-IL-17A, and anti-tumor-necrosis factor (TNF)-α, were demonstrated to limit the cytokine storm involved in the pathogenesis of COVID-19 disease by modulating specific cytokines [1]. Herein we report our experience regarding the biologic treatment of psoriasis patients during the COVID-19 pandemic at the University of Naples Federico II, Italy. During the pandemic (February 25, 2020, to June 25, 2020), 965 psoriasis patients (mean age 52.1 years, male 58.5%) on biologics were interviewed about having been infected with SARS-CoV-2 virus, having had COVID-19 suspected symptoms (fever, dyspnea, cough, malaise), or having had contact with positive patients. Moreover, they were questioned about withdrawal or change in the due schedule of administration of biologics and, if so, whether the decision was voluntary or based on medical advice (Table 1). Of the 965 interviewed patients, 311 (32.2%) were under anti-TNF-α, 346 (35.8%) under IL-17, 64 (6.6%) under anti-IL-23 therapy and 244 (25.0%) on anti-IL-12/23. Our analysis highlighted that 16/965 patients (1.6%) suspended the treatment during the pandemic: 3 (18.7%) after seeking medical advice for fever and/or cough, while the remaining (81.2%) were moved by the fear of being more susceptible to the infection. Likewise, 7 patients (0.7%) delayed the administration of the biologic: 5 (71.4%) voluntarily, while 2 (28.6%) were instructed to suspend by the doctor after the occurrence of fever and/or cough. Interestingly, only 1 patient (0.1%), male and aged 74 years, with hypertension, contracted SARS-CoV-2 infection: although asymptomatic, he precautionarily suspended adalimumab for 1.5 months and restarted it after 2 negative swab results. He observed the house quarantine and did not require hospitalization or any related treatment. Likewise, only a healthy 43-year-old woman (0.1%) declared a strict contact with a SARS-CoV-2-positive patient but did not develop the infection. She precautionarily suspended etanercept and observed the quarantine, without hospitalization, then reintegrating the biologic. Our data support that biologics may neither represent a risk factor for SARS-CoV-2 infection nor for a more severe disease. Such statements are in line with the most recent findings about the topic, as shown from the analysis run in two high-epidemic areas (n = 159 patients at Bergamo Hospital and n = 139 patients at Lecco Hospital, both treated with biologics), and so encourage adherence to biologics given the well-known effects at withdrawal such as flares and resistance to further treatments [2, 3, 4, 5]. In this context, biologics for psoriasis seem to be an effective and safe therapy also during the COVID-19 pandemic. However, more research is needed to give consistency to our data and establish international guidelines on the management of psoriasis during the pandemic. Limitations Our study's limitations are the relatively short time of follow-up (4 months) and the lack of a control group (e.g., patients under conventional systemic treatments). Statement of Ethics The study was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. Patients gave their written consent. Conflict of Interest Statement The authors have no conflicts of interest to declare. Funding Sources No funding is to declare. Author Contributions Elisa Camela: conception and design of the work. Gabriella Fabbrocini: acquisition, analysis, and interpretation of data for the work. Eleonora Cinelli: drafting the work for important intellectual content. Wanda Lauro: revising the work critically. Matteo Megna: final approval of the version to be published.
                Bookmark

                Author and article information

                Journal
                J Cosmet Dermatol
                J Cosmet Dermatol
                10.1111/(ISSN)1473-2165
                JOCD
                Journal of Cosmetic Dermatology
                John Wiley and Sons Inc. (Hoboken )
                1473-2130
                1473-2165
                28 October 2021
                December 2021
                28 October 2021
                : 20
                : 12 ( doiID: 10.1111/jocd.v20.12 )
                : 4073-4075
                Affiliations
                [ 1 ] Section of Dermatology – Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
                Author notes
                [*] Correspondence

                Matteo Megna, Section of Dermatology Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy.

                E‐mail: mat24@ 123456libero.it

                Author information
                https://orcid.org/0000-0001-5940-0592
                https://orcid.org/0000-0001-7201-9163
                https://orcid.org/0000-0003-1803-2046
                Article
                JOCD14550
                10.1111/jocd.14550
                8662296
                34708906
                da008cbe-b254-4cfa-bbe2-7e5c32221dd9
                © 2021 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 28 September 2021
                : 13 August 2021
                : 11 October 2021
                Page count
                Figures: 0, Tables: 1, Pages: 0, Words: 1465
                Categories
                Letters to the Editor
                Letters to the Editor
                Custom metadata
                2.0
                December 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.9 mode:remove_FC converted:10.12.2021

                Dermatology
                biologic treatment,covid‐19,psoriasis,psoriasis management
                Dermatology
                biologic treatment, covid‐19, psoriasis, psoriasis management

                Comments

                Comment on this article