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Biologics for Psoriasis and the Risk of COVID-19

Written by Kelly Crumrin
Posted on February 8, 2021

  • Biologics treat psoriasis by blocking the action of specific immune proteins that promote inflammation.
  • Increased risk for infection is a potential side effect of using biologics.
  • Your individual risk for infection depends on many factors, including age, other health conditions, and which medications you currently use or have used in the past.
  • National Psoriasis Foundation guidelines, among other sources, recommend people with psoriasis do not stop prescribed treatment before talking to their doctor.

Since the COVID-19 pandemic is a rapidly evolving situation, guidance on disease management issued by medical societies is subject to change. The information contained in this article represents what is believed to be the most relevant COVID-19-related guidance based on the most up-to-date publications as of December 14, 2020.

Biologics are a class of therapeutic products produced by living cells using biotechnology.1 According to the U.S. Food and Drug Administration (FDA), biologics are the nation’s fastest-growing class of therapeutics.1 Since biologics were introduced to treat psoriasis and psoriatic arthritis — collectively known as psoriatic disease — they have changed many doctors’ approaches to managing these chronic conditions.2

With the ongoing COVID-19 pandemic, many people with psoriatic disease on biologics are concerned about whether their medications raise the risk for contracting the coronavirus or for experiencing severe symptoms if they become infected.

How Do Biologics Affect the Immune System?

Biologics for psoriasis are drugs that work by targeting specific aspects of the immune system.3 For instance, biologic drugs may be designed to block the action of certain proteins.3 Different classes of biologics for psoriatic disease target different cytokines — immune proteins that promote inflammation — including tumor necrosis factor (TNF) alpha, interleukin 17 (IL-17), and interleukin 23 (IL-23).4

The table below lists biologics approved by the FDA to treat psoriasis or psoriatic arthritis — or both — categorized by class.

Biologics and Traditional Oral Drugs That Affect the Immune System: Infection Risk

All drugs carry the risk of potential side effects.5 Methotrexate and corticosteroids, such as Prednisone, are examples of traditional oral drugs sometimes used to treat psoriatic disease. These drugs impact the entire immune system and carry a risk for developing an infection.3

Biologics, even though they are more targeted in how they impact the immune system, also carry a risk for infection. Your personal risk for experiencing a particular side effect may depend on many factors, including your age, gender, and other drugs you may be taking.6 Before prescribing biologics, doctors screen people for factors that may contribute to the risk for infections.4

In general, people with psoriatic arthritis have a greater risk for serious infections than those with psoriasis. Researchers associate this higher risk with other risk factors common in people with psoriatic arthritis, including older age, additional health problems, and greater use of steroids.7

Available Information Regarding Biologics and COVID-19

In early September 2020, the National Psoriasis Foundation COVID-19 Task Force updated its guidance on the management of treatment for people with psoriatic disease. Current guidelines recommended that people who are not infected with the coronavirus continue their biologic or oral therapies for psoriatic disease in most cases. Shared decision-making between you and your health care providers is recommended to guide discussions about the treatment of psoriatic disease during the pandemic.8

Managing Concerns About Biologics During the COVID-19 Pandemic

Doctors who treat psoriasis and psoriatic arthritis have been actively monitoring and discussing the risks of biologics since the beginning of the COVID-19 pandemic. The International Psoriasis Council (IPC) recognizes psoriasis as an important chronic disease that requires long-term treatment to help prevent associated complications.9 Physical and psychological risks of delaying or interrupting treatment should be considered and balanced with individual risk factors for side effects from the biologic. If you have COVID-19 or are experiencing symptoms of COVID-19, you should alert your doctor right away. Your doctor will evaluate your individual situation and may advise you to discontinue or hold your treatment.

Here are some points to consider:

  • Discontinuing biologics can lead to worsening symptoms of psoriasis and psoriatic arthritis.10
  • Individuals newly diagnosed with psoriasis and/or psoriatic arthritis, or those who are currently not receiving treatment, should be aware that untreated psoriatic disease may impact health. In the case of psoriatic arthritis, this can lead to permanent joint damage and disability. Shared decision-making between you and your doctor is recommended to guide discussions about the use of systemic therapies (taken orally or by injection) during the pandemic.8
  • Especially in cases of severe psoriasis, some people who discontinue biologics may become resistant to the therapy, meaning it may not be as effective if they start it again later.11
  • Biologics may increase the risk of infections and other side effects.

Taking Steps To Stay Healthy

Whatever decisions you and your doctor make regarding your psoriasis treatment, it is more important than ever to take steps to protect your health. Below are some recommendations on how to remain healthy during the COVID-19 pandemic:

  • Ask your doctor to help you better understand your personal risk factors for contracting the coronavirus and other infections.
  • Communicate openly with your doctor about your psoriasis symptoms. Consider using telehealth to avoid the risk of exposure to the coronavirus.
  • If your current therapy is not helping you meet your psoriasis treatment goals, learn more about managing psoriasis during the pandemic.
  • Read more about psoriasis treatment during COVID-19.
  • Follow these tips for staying safe during COVID-19.

On MyPsoriasisTeam, members support each other and share their experiences treating psoriasis and psoriatic arthritis. Join more than 84,000 members as they face the challenges of psoriatic disease and the COVID-19 pandemic together.

References
  1. Center for Drug Evaluation and Research. (2017, October 23). About Biosimilars and Interchangeable Products. Retrieved December 18, 2020, from https://www.fda.gov/drugs/biosimilars/biosimilar-and-interchangeable-products
  2. Kamata, M., & Tada, Y. (2020). Efficacy and Safety of Biologics for Psoriasis and Psoriatic Arthritis and Their Impact on Comorbidities: A Literature Review. International journal of molecular sciences, 21(5), 1690. https://doi.org/10.3390/ijms21051690
  3. Biologics and Biosimilars for Psoriasis. (2020, October 01). Retrieved December 18, 2020, from https://www.psoriasis.org/biologics/
  4. American Academy of Dermatology Association. Accessed Sept. 30, 2020 at https://www.aad.org/public/diseases/psoriasis/treatment/medications/biologics
  5. Alshammari, T. M. (2016). Drug safety: The concept, inception and its importance in patients’ health. Saudi Pharmaceutical Journal, 24(4), 405-412. doi:10.1016/j.jsps.2014.04.008
  6. Center for Drug Evaluation and Research. (2019, July 19). Learning about Side Effects. Retrieved December 18, 2020, from https://www.fda.gov/drugs/information-consumers-and-patients-drugs/finding-and-learning-about-side-effects-adverse-reactions
  7. Li, X., Andersen, K. M., Chang, H. Y., Curtis, J. R., & Alexander, G. C. (2020). Comparative risk of serious infections among real-world users of biologics for psoriasis or psoriatic arthritis. Annals of the rheumatic diseases, 79(2), 285–291. https://doi.org/10.1136/annrheumdis-2019-216102
  8. Gelfand, J., Armstrong, A., Bell, S., Anesi, G., Blauvelt, A., Calabrese, C., . . . Ritchlin, C. (2020, September 04). National Psoriasis Foundation COVID-19 Task Force Guidance for Management of Psoriatic Disease During the Pandemic: Version 1. Retrieved December 18, 2020, from https://www.jaad.org/article/S0190-9622(20)32544-5/fulltext
  9. IPC Statement on COVID-19 and Psoriasis. (2020, September 1). Retrieved December 18, 2020, from https://www.psoriasiscouncil.org/blog/COVID-19-Statement.htm
  10. Megna, M., Napolitano, M., Patruno, C., & Fabbrocini, G. (2020). Biologics for psoriasis in COVID ‐19 era: What do we know? Dermatologic Therapy, 33(4). doi:10.1111/dth.13467
  11. Ebrahimi, A., Sayad, B., & Rahimi, Z. (2020). COVID-19 and psoriasis: Biologic treatment and challenges. Journal of Dermatological Treatment, 1-5. doi:10.1080/09546634.2020.1789051
Posted on February 8, 2021
All updates must be accompanied by text or a picture.

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Kelly Crumrin is a senior editor at MyHealthTeam and leads the creation of content that educates and empowers people with chronic illnesses. Learn more about her here
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