Biologics, Psoriasis, and COVID-19

Because Coronavirus infection is so new, we do not have any or data on whether Biologics make patients susceptible to coronavirus infection. We do, however, have data from clinical trials which report other viral and respiratory infections. The numbers are small, but if there’s any risk susceptibility to other viral infections, the risk appears to be low with most of the Biologics used for psoriasis.
Dr. Craig Singer has not been discontinuing drugs that block IL-17 (Cosentyx, Taltz, and Siliq) or drugs that block IL-23 (Tremfya, Skyrizi, or Ilumya) because the risk appears to be very small.
It does appear that TNF blockers (Remicade, Enbrel, Humira, and Cimzia) may make patients more susceptible to infection, so Dr. Singer has been offering these patients the opportunity to switch to one of the new drugs that appear to have a lower risk of infection. We advise patients:  if you are on a TNF blocker (Enbrel, Humira, or Remicade) make an appointment and we will try to expedite that to make the switch sooner.
Because Stelara blocks 2 molecules  (Il-12 and IL-23), and IL-12 may play a role in the development of viral infections, we are offering patients on Stelara the option of  switching to IL- 23 blocking drugs which block less of the immune system and are even more effective at treating psoriasis. In registries, Stelara has not been shown, however, to increase infections although we obviously don’t have any data on the coronavirus. 
 
Methotrexate and Cyclosporine are immunosuppressive, so take all precautions to avoid exposure to this virus and discuss alternative therapies with us.
            Otezla is a phosphodiesterase inhibitor (similar to caffeine) and has not been associated with an increased risk of infections. Likewise, Soriatane is related to vitamin A and does not increase the risk of infection.
For patients on Dupixent for atopic dermatitis, Dupixent is an immunomodulator, not an immunosuppressive.  It lowers elevated levels of a chemical called IL-4 to normal levels and has not been associated with an increase in respiratory infections.

FAQ

  1. If I develop Coronavirus infection, what should I do with my biological agent?
Answer: We recommend stopping it until your infection is clear and you are completely asymptomatic.
 
  1. I am completely clear on Stelara. My last injection two weeks ago. Should I be worried about Coronavirus?
Answer: We advise that you wait until we are closer to your next injection. If there are still fears regarding Coronavirus, these are your options (1) continue Stelara, (2) switch to IL 23 blocker  (3) wait for your psoriasis to flare and reevaluate.
 
    1. Isn’t it better to just stop the biological agent now until this epidemic blows over?                                                                                Answer: The main issue that when you stop your biological agent and then restart it, the biological agent may not work as well as it did previously. Studies show anywhere from 5% to 25% of people do not respond anymore to their previously effective biological therapies.
  1. I am currently taking Humira (or Cimzia), do I have to switch my biological this time?
Answer: Not necessarily. However, these agents may increase your risk acquiring more significant Coronavirus infection as opposed to IL-17 inhibitors (Taltz, Cosentyx). You’ll need to take increased precautions for avoidance of exposure (e.g. work from home).