key: cord-341999-nosdj7b2
authors: Conti, A.; Lasagni, C.; Bigi, L.; Pellacani, G.
title: Evolution of COVID‐19 infection in 4 psoriatic patients treated with biological drugs
date: 2020-05-07
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16587
sha: 
doc_id: 341999
cord_uid: nosdj7b2

Since December 2019, the pandemic coronavirus disease (2019‐nCoV; COVID‐19) has changed the approach to all dermatological diseases; in particular, psoriatic patients undergoing immunosuppressive drugs, such as biologics, can potentially show an increase risk of infection (1). However, few reports are available on the course of COVID‐19 infection in psoriatic patients treated with biological drugs (2). We describe a case series of four psoriatic patients treated with biologics who had a risk contact with COVID‐19.

Since December 2019, the pandemic coronavirus disease (2019-nCoV; COVID-19) has changed the approach to all dermatological diseases; in particular, psoriatic patients undergoing immunosuppressive drugs, such as biologics, can potentially show an increase risk of infection (1) .

However, few reports are available on the course of COVID-19 infection in psoriatic patients treated with biological drugs (2) . We describe a case series of four psoriatic patients treated with biologics who had a risk contact with COVID-19. 

This article is protected by copyright. All rights reserved In the last two cases, the biologic therapy was interrupted only during the quarantine period, without worsening of psoriasis and no test has be done for COVID-19.

In SARS-CoV-2 infection the immune response plays an important role in the development of an excessive inflammatory response, which can evolve towards an acute respiratory distress syndrome (ARDS), potentially lethal for the patient (3). Some key cytokines in the pathogenesis of psoriasis, such as Tumor Necrosis Factor Alpha (TNF-α) and Interleukin 17 (IL17) are increased in inflammatory response to coronavirus and viral pneumonia, while IL-23 does not seem to be essential for an effective immune response (4) . The increase in inflammatory cytokines is associated to a worsening of clinical conditions of the patients affected by SARS-CoV-2 (3, 5) . Based on these observations, it has been hypothesized that anti-TNF-α or anti-IL17 drugs could play a potential role to improve COVID-19's "cytokine storm" and ARDS (6) . For this reason, the use of ixekizumab and adalimumab associated to antiviral drugs are currently studied in China in the treatment for Covid-19 (7, 8) .

Despite the presence of risk factors for a worse prognosis (hypertension, diabetes, obesity, male gender), only one patient presented a severe form of SARS-CoV-2, while another one a mild form.

Despite a prolonged contact with subjects with COVID-19 infection, the other two cases did not show any symptoms. This could explain the positive course of COVID-19 infection in our four cases, where ongoing treatment with biological drugs could play a protective role against the onset and the evolution of the infection. Further studies are needed to investigate this hypothesis.

Should biologics for psoriasis be interrupted in the era of COVID-19?

SARS-CoV-2 infection in a psoriatic patient treated with IL-23 inhibitor

Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Inhibition of the inflammatory cytokine tumor necrosis factoralpha with etanercept provides protection against lethal H1N1 influenza infection in mice

Research progress on the mechanism of cytokine storm induced by new coronavirus pneumonia and related immunotherapy

Reducing mortality from 2019-nCoV: host-directed therapies should be an option

A randomized, blinded, controlled, multicenter clinical trial to evaluate the efficacy and safety of Ixekizumab combined with conventional antiviral drugs in patients with novel coronavirus pneumonia

A clinical study for the efficacy and safety of Adalimumab Injection in the treatment of patients with severe novel coronavirus pneumonia

Accepted Article