Should biologic medications be continued during the COVID-19 outbreak?

There are many biologic medications that are used to treat severe cases of chronic skin conditions like psoriasis and atopic dermatitis. Examples include Enbrel, Humira, Stelara, Cosentyx, Taltz, Tremfya, Skyrizi, Remicade, Siliq, Ilumya, Cimzia, and Dupixent. These medications work by interfering with signaling in the immune system. As such, biologic medications may affect the ability of the immune system to fight certain infections. Stopping treatment with a biologic medication may cause a flare in a patient’s skin condition that is otherwise well controlled. The challenge is deciding if it is safer to risk a flare by halting immunosuppressive therapy to avoid infection with coronavirus.

It is unclear how coronavirus (COVID-19) infections are affected by biologic medications, and there are currently no formal recommendations from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) on the use of biologics during the outbreak. Many physician groups have made statements to help guide treatment decisions for practitioners and patients.

 For example, the American Academy of Dermatology (AAD) released a statement on March 18th, 2020. It said that “…for patients on biologic therapy who have not tested positive or exhibited signs/symptoms of COVID-19 there is insufficient evidence to recommend discontinuation of biologics at this time.” The AAD recommends that physicians weigh the risks and benefits of biologic medication on a case-by-case basis. Considerations should include the diagnosis, severity of the skin disease, patient age, and existence of other medical conditions, such as diabetes, respiratory disease, and heart disease.

 The AAD suggests that biologic medications be discontinued or postponed in patients who have tested positive for COVID-19 until recovery from the infection.

 In the scenario where a patient is considering starting a biologic medication, the AAD recommends that low-risk patients be addressed on a case-by-case basis, and that high-risk patients defer starting biologics and instead seek other treatment options.

The bottom line is that as the medical community learns more about coronavirus on a daily basis, the decision to stop a biologic medication is an individual decision that should be made in collaboration with a doctor.

To that end, while the physical offices of MDCS Dermatology are closed to routine and non-essential activities for the time being, you can reach us virtually through a teledermatology visit, at MDCS Teledermatology Video Visit.

 

 

Author
Brendan Camp, MD FAAD Board certified dermatologist at MDCS Dermatology

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