Biological therapy of psoriasis in the era of COVID-19: discussing the risks and benefits

BACKGROUND: The new coronavirus infection COVID-19 in 2020 has spread widely around the world, including the Russian Federation. Risk factors for adverse outcomes of COVID-19, such as obesity, diabetes, chronic heart and kidney diseases, non-alcoholic fatty liver hepatosis, often accompany psoriasis, especially severe. Assessment and reduction of these risks have become an integral task of psoriasis therapy. An important issue was the use of immunosuppressive therapy in patients during the pandemic.

AIMS: In this article, we tried to analyze the international experience of colleagues with a focus on psoriasis and correlate it with our own experience. To assess the impact of psoriasis, concomitant syndromes and applied biological and non-biological systemic therapy on the risk of infection and the nature of the course of COVID-19.

MATERIALS AND METHODS: The analysis of available scientific publications on the effect of psoriasis, concomitant comorbidities and the therapy used on the incidence, nature of the course and outcomes of the new coronavirus infection COVID-19 was carried out. Data collection (questionnaire and analysis of available medical documentation on transferred COVID-19 cases and detection of antibodies) and a retrospective analysis of the history of COVID-19 disease in psoriasis patients in the Republic of Crimea who are on dispensary registration and receiving systemic (biological and targeted) therapy (n=146) were performed. The search for articles on the topic was carried out in the PubMed database in English and Russian, published in the period from 2019 to 2021.

RESULTS: According to available literature data, systemic biological drugs from the group of interleukin inhibitors for the treatment of psoriasis did not worsen the course of COVID-19.

Established a proactive anti-inflammatory effect for drugs from the group of IL-17 inhibitors.

According to the latest version 14 of the recommendations for the treatment of COVID from 27.12.2021, the IL-17A inhibitor netakimab is included in the group of drugs of proactive anti-inflammatory therapy. Out of 146 patients with psoriasis receiving biological and targeted therapy, 8 patients underwent acute respiratory infections in 18 months, confirmed COVID-19 was established in 26 cases, antibodies were detected in 54 patients. Out of the patients with pneumonia and COVID-19, hospitalization for biological therapy was not required and only one case of hospitalization for therapy with apremilast (CT 1) was recorded. It should be noted that in the families of patients undergoing biological therapy, there were cases of COVID-19 (CT 2–3) and even a fatal outcome, however, no clinical manifestations of the disease were observed in our patients, and antibodies were detected during laboratory examination.

CONCLUSIONS: To date, there is no convincing evidence that drugs for systemic therapy of psoriasis can worsen the course of COVID-19. A proactive anti-inflammatory effect was noted for drugs from the group of IL-17 inhibitors. The existing international and Russian recommendations on the management of patients on biological therapy in the COVID-19 pandemic reflect the current experience and views of the expert community, it is necessary to further accumulate new data and exchange clinical experience along with the evolution of the pandemic. Available vaccines against COVID-19 that are not live may be used with caution during immunosuppressive therapy.