AAD issues guidance on biologic use during COVID-19
In response to the COVID-19 outbreak, the American Academy of Dermatology has issued a guidance on the use of biologic agents. The document was created on March 18, 2020, and is subject to change as the pandemic develops.
In the statement, it is noted that the CDC and the WHO have not yet offered guidance on how dermatologists should manage the immunomodulatory effects of biologic therapy in their patients. Moreover, there are no data on the risk profile of biologic therapies for COVID-19.
“A main priority for dermatologists, at this point, is to keep our patients out of emergency rooms and urgent care so as to not tax the health care system unnecessarily,” according to the guidance. “Dermatologists must delicately balance the risk of immunosuppression with the risk of disease flare requiring urgent intervention.”
With this in mind, it is strongly recommended by the AAD that patients should not cease biologic therapy without consulting the treating physician. Specifically, the Academy offers three bullet points for dermatologists to follow.
The first pertains to patients currently being treated with biologic therapy who have not tested positive for COVID-19 and display no signs or symptoms of the infection. There is currently insufficient evidence to support cessation of biologics in these patients. However, physicians are encouraged to conduct a risk-benefit assessment for each case patient. Factors in this analysis should include “original indication for the biologic, the severity of the original indication, the patient’s age (whether they are 60 years old) and comorbidities,” according to the guidance. Cardiovascular disease, diabetes, severe hypertension, liver disease, kidney disease, a compromised respiratory system, internal malignancies or tobacco use are the key comorbidities that should fall under consideration.
The second bullet point pertains to patients currently being treated with biologics who test positive for COVID-19. In these cases, the Academy recommends discontinuation or postponement of biologic therapy until the patient recovers from the infection.
The third point pertains to patients currently being considered as candidates for biologic therapy. A risk-benefit assessment is recommended in these cases, as well. The aforementioned series of high-risk comorbidities should be considered. Dermatologists may consider alternative therapeutic approaches for patients who fall into the high-risk category.
For dermatologists who wish to find up-to-date information on biologic therapies and other pertinent details of COVID-19, the Academy recommends visiting the CDC and WHO websites, along with recommendations from the International Psoriasis Council and the American College of Rheumatology. – by Rob Volansky