key: cord-0766054-1qg77q2d authors: Kado, Soichiro; Kamiya, Koji; Kishimoto, Megumi; Maekawa, Takeo; Kuwahara, Aya; Sugai, Junichi; Komine, Mayumi; Ohtsuki, Mamitaro title: Single‐center survey of biologic use for inflammatory skin diseases during the coronavirus disease 2019 pandemic date: 2021-09-21 journal: J Dermatol DOI: 10.1111/1346-8138.16159 sha: d91f662c73199d7aa123dfc1f746ae553cf1406f doc_id: 766054 cord_uid: 1qg77q2d Coronavirus disease 2019 (COVID‐19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). The ongoing COVID‐19 pandemic has affected both daily life and medical care; therefore, the aim of this study was to analyze the use of biologics for inflammatory skin diseases during the COVID‐19 pandemic in our hospital. The observation period was between 1 January 2020 and 23 February 2021. In this study, we enrolled 227 patients with psoriasis, six patients with palmoplantar pustulosis (PPP), 69 patients with atopic dermatitis (AD), and five patients with hidradenitis suppurativa (HS). Bioswitch was performed in 25 patients with psoriasis (11.0%). Biologics were discontinued in 14 patients with psoriasis (6.2%), 10 patients with AD (14.5%), and four patients with HS (80.0%); they were not discontinued in patients with PPP. The introduction of biologics was observed in 27 patients with psoriasis (11.9%), four patients with PPP (66.7%), 33 patients with AD (47.8%), and two patients with HS (40.0%). The use of telephone consultations was observed in four patients with psoriasis and two patients with AD. One patient, who received adalimumab for the treatment of psoriatic arthritis, suffered from COVID‐19 and recovered after a mild course. In conclusion, we report our experience regarding the use of biologic drugs for inflammatory skin diseases. The use of biologics seemed safe for use amidst COVID‐19 infection during the observation period; however, further observation on a larger number of patients is required to confirm the risks and benefits of biologic use in the COVID‐19 era. GUS has been used for the treatment of PPP, while dupilumab (DUP), which inhibits IL-4 and IL-13, has been used for AD, and ADA for HS. Biologics can provide significant symptomatic improvement that cannot be obtained with other types of therapies; 7-10 however, it is unclear whether they suppress the immune system and increase the risk of COVID-19. Despite the severity of the disease, patients might discontinue their treatment, as well as hesitate to start biologic therapy or visit our hospital during the COVID-19 pandemic, for fear of infection. In this study, we analyzed the trend of biologic use for psoriasis, PPP, AD, and HS during the COVID-19 pandemic at the Jichi Medical University, Japan. This study was approved by the Ethical Committee of Jichi Medical University. Patients with psoriasis, PPP, AD, or HS who received biologic therapy between 1 January 2020 and 28 February 2021 at the Jichi Medical University were enrolled in this study; the data were retrospectively collected from the electronic medical records. A survey was designed to acquire information regarding patients' characteristics, prior medical history and comorbidities, the incidence of COVID-19, discontinuation and introduction of biologics, and use of telephone consultations. In patients with psoriasis, bioswitch was also analyzed for each drug and each type of psoriasis; the types of psoriasis included psoriasis vulgaris (PsO), psoriatic arthritis (PsA), generalized pustular psoriasis (GPP), and erythrodermic psoriasis (EP). For psoriasis, the severity of skin lesions was evaluated using the Psoriasis Area and Severity Index (PASI). 11 For PPP, the severity was evaluated using the PPP Area and Severity Index (PPPASI). 12 The severity of AD was evaluated via the Investigators' Global Assessment (IGA) and Eczema Area and Severity Index (EASI), 13 Bioswitch was performed in 25 patients with psoriasis (11.0%) during the observation period (18 males and seven females; Table 2) due to the insufficient therapeutic effects; the average age of the patients was 54.0 ± 14.8 years. The number of switches from a TNF inhibitor to another TNF inhibitor or IL-17 inhibitor were one and four cases, respectively. The number of switches from an IL-12/23 inhibitor to either an IL-23 inhibitor or IL-17 inhibitor were three and one case, respectively. The number of switches from an IL-23 inhibitor to another IL-23 inhibitor or IL-17 inhibitor were five and two cases, respectively. The number of switches from an IL-17 inhibitor to a TNF inhibitor or another IL-17 inhibitor were five and four cases, respectively. Focusing on each type of psoriasis, bioswitch was performed in 12 patients with PsO, 10 patients with PsA, two patients with GPP, and one patient with EP (Table S1) . Biologics were discontinued in 14 patients with psoriasis (6.2%; eight males and six females) ( In this study, a total of 307 patients with inflammatory skin diseases were enrolled; the use of telephone consultations was observed in six patients (0.2%; psoriasis: four cases; AD: two cases; Table S4 ). The number of use was 1-3 times. There were no patients who continuously used telephone consultations. A recent epidemiological study demonstrated that skin conditions, including psoriasis and AD, increased the risk of COVID-19, but decreased the risk of a severe course. 16 In a nationwide Korean cohort, allergic rhinitis and asthma, but not AD, were associated with an increased susceptibility to SARS-CoV-2 infection and severe clinical outcomes for COVID-19. 17 By contrast, no epidemiological studies have analyzed the association between PPP or HS and COVID-19. Biologics used for treatment of psoriasis may be beneficial against COVID-19, 18 and DUP is not considered to increase the risk of viral infections. 19 The Centers for Disease Control and Prevention classified the following comorbidities as established risk factors for severe COVID-19: cancer, CKD, COPD, Down syndrome, heart conditions, immunocompromised state, obesity, pregnancy, sickle cell disease, smoking, and type 2 DM. 20, 21 In our study, one male patient who received ADA for the treatment of PsA suffered from COVID-19 during the observation period; he had a history of smoking, as well as type 2 DM and cardiovascular disease. His clinical course was mild, and he exhibited no noticeable symptoms other than a high fever, fully recovering after 7 days of hospitalization. His PsA symptoms were successfully treated with ADA (40 mg; every 2-3 months), and COVID-19 was confirmed 2 months after the last administration; thus, the association between COVID-19 and ADA was unclear. At the beginning of the COVID-19 pandemic, it was unknown whether biologics should be discontinued due to their immunosuppressive effects. The rate of discontinuation varied within different areas during the pandemic, 22-25 possibly due to the regional status Additionally, although telephone consultations were performed on the day of the scheduled visits, the patients' condition could not be visually assessed due to the lack of remote monitoring systems. An established system for telemedicine is thus required during the COVID-19 pandemic, which may change the provision of medical care in the post-COVID-19 era. The limitations of this study include its nature as a single-center study, the small sample size, limited data from the medical records, retrospective analysis, and the absence of statistical analysis. Nevertheless, the aim of our study was not to investigate the incidence of COVID-19 infection, but to report the use of biologics for inflammatory skin diseases during the COVID-19 pandemic. In conclusion, we report our experience regarding the use of biologics for psoriasis, PPP, AD, and HS during the COVID-19 pandemic. To our knowledge, this is the first epidemiological study to examine the use of biologics for inflammatory skin diseases during the COVID-19 pandemic in Japan. Confirming the efficacy and safety of biologic use would require more evidence-based data. None declared. 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