Use of biologics during the COVID-19 pandemic: lessons learned from psoriasis

ABSTRACT

Introduction

Given the increased infectious risk associated with biologics, particularly with TNFα inhibitors, concerns were raised over the safety of these agents in relation to SARS-CoV-2 infection. Furthermore, the impact of biologics on SARS-CoV-2 vaccination was questioned.

Areas covered

In this review, studies conducted on patients with moderate to severe plaque psoriasis treated with biologics during the COVID-19 pandemic have been analyzed, including 1) the safety of biologics in psoriatic patients in terms of increased risk and/or worse outcome of SARS-CoV-2 infection; and 2) whether biologic agents could affect the safety and response to SARS‐CoV‐2 vaccines in psoriatic patients.

Expert opinion

Current evidence indicates that the use of biologics in psoriatic patients does not seem to be associated with an increased COVID-19 infection risk or worse outcome, with TNFα inhibitors being even protective of severe COVID-19 relative to other treatments or no treatment at all. Furthermore, biologic treatment does not seem to have a significant impact on the response and safety of vaccines in patients with psoriasis treated with biologics. However, uncertainty remains given the limitations of current studies which are often of short duration, limited sample sizes and do not stratify on specific biologic classes.

KEYWORDS:

• Biologics
• psoriasis
• pandemic
• COVID-19
• SARS‐CoV‐2
• vaccination

Article highlights

• A consistent amount of research showed no increased risk of COVID-19 infection or worse outcome in psoriatic patients treated with biologics, particularly with TNFα inhibitors.

• No serious safety concerns were raised in psoriatic patients on biologics vaccinated with SARS‐CoV‐2 vaccines.

• Psoriasis flare-ups following SARS‐CoV‐2 vaccination have been described, but they should not discourage vaccination as they appear to be rare, and a causal relationship is not established as it is based on sporadic spontaneous case reports whereas billions of doses of COVID-19 vaccines have been administered globally.

• Psoriatic patients on biologics were shown to have a similar antibody response to controls after SARS‐CoV‐2 vaccination, unlike those on nonbiologic agents such as methotrexate.

• However, uncertainty remains given the limitations of current studies which are often of short duration, limited sample sizes and do not stratify on specific biologic classes.

Declaration of interest

P Gisondi has been a consultant and/or speaker for Abbvie, Almirall, Amgen, Janssen, Leo-pharma, Eli Lilly, Novartis, Pierre Fabre, Sandoz, Sanofi and UCB. G Girolomoni has served as consultant and/or speaker for AbbVie, Almirall, Amgen, Biogen, Boehringer-Ingelheim, Bristol-Meyers Squibb, Eli-Lilly, Leo Pharma, Novartis, Pfizer, Regeneron, Samsung bioepis, Sanofi and UCB. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they consult and/or receive grants from many companies that make psoriasis products and that they are a member of the National Psoriasis Foundation Task Force on COVID-19. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was funded by Fondazione Cariplo ID Project 2020-1363 (Title: Impact of COVID-19 infection on patients affected by inflammatory skin disease on immuno-suppressive therapies COVISKIN).