Psoriasis and hidradenitis suppurativa during COVID-19: keep calm and carry on

In the management of patients with chronic dermatologic diseases during the pandemic, many questions have arisen. Guidance is provided by various experts.

“Our discussion about biologics needs to be contextualised with regard to which phase of COVID-19 the patient might be in,” explained Prof. April W. Armstrong (University of Southern California, USA) [1,2]. She started by looking at various clinical trial results in a meta-analysis for respiratory tract infection (RTI). Concerning TNF inhibition for psoriasis and hidradenitis suppurativa (HS), RTI rates were comparable between the various study drugs and placebo [2,3]. Moreover, RTI data in psoriasis trials with IL-17 inhibitors was not different between IL-17 inhibitor treatment and placebo in most cases. Furthermore, no increased risk of RTI was found for IL-23 inhibitors in phase 3 trials [1]. Even the likelihood of viral infections was not elevated either with IL-23 or IL-12/23 inhibition, the latter in the absence of concomitant immunosuppressants.

Also available are real-world findings. A US investigation of real-world data concluded that treatment with biologics and JAK inhibitors was not associated with higher odds of a hospitalisation for COVID-19 [4]. Similar conclusions were drawn from an Italian study including 980 psoriasis patients on biologics [5]. Research from Detroit, however, found an increased hospitalisation rate in case of multidrug treatment for psoriasis and psoriatic arthritis (PsA) [6]. Nonetheless, monotherapy with biologics and especially TNF inhibition reduced this rate.

In light of the available research findings, the COVID-19 Taskforce of the National Psoriasis Foundation stated that therapy for psoriasis and PsA generally involves no meaningful alteration in the risk of acquiring COVID-19, nor of having a worse outcome. Thus, patients should continue their biologic or oral therapies [7,8]. Although corticosteroids can be beneficial for COVID-19 patients in need of oxygen therapy, chronic systemic steroids for PsA should be avoided, if possible, as they may contribute to worse outcomes in case of acute infection. The timing of the restart of treatment after infection should be a matter of individual case evaluation. “The general guidance is that most patients can restart their psoriasis and/or PsA treatments after complete resolution of COVID-19 symptoms,” said Prof. Armstrong. She also indicated that vaccinations for psoriasis patients are encouraged under ongoing biologic or oral therapies.

The impact of systemic treatment on COVID-19 and HS was evaluated and expert opinions of the HS Foundation have been issued [9]. “I certainly reference these when I manage my patients with HS,” stated Prof. Armstrong. “Patients who are well controlled on a stable treatment regimen should probably continue that regimen including immune-modulating agents whether it is a biologic or an oral agent,” she said. Prof. Armstrong also pointed to the importance for HS patients who develop COVID-19 symptoms of getting in touch with their physician to discuss whether there is an indication for delaying a dose of their treatment.

1. Armstrong AW. Covid-19 and biologics. Session S028, AAD VMX 2021, 23-25 April.
2. Syed MN, et al.J Am Acad Dermatol. 2020;83(5):1523-1526.
3. Blaszczak A, et al. J Am Acad Dermatol. 2020;83(1):e31.
4. Haberman R, et al. N Engl J Med. 2020;383(1):85-88.
5. Gisondi P, et al. J Am Acad Dermatol. 2020;83(1):285-287
6. Veenstra J, et al. J Am Acad Dermatol. 2020;83(6):1696-1703.
7. Gelfand JM, et al. J Am Acad Dermatol. 2020;83(6):1704-1716.
8. COVID-19 Task Force Guidance Statements 2021. Retrieved from psoriasis.org/covid-19-task-force-guidance-statements on 20 May 2021.
9. HS Foundation 2021. Retrieved from hs-foundation.org/frequently-asked-questions-about-hidradenitis-suppurativa-hs-and-covid-19 on 20 May 2021.

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Posted on 7 June 202117 May 2024