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Navigating immunosuppression in a pandemic: A guide for the dermatologist from the COVID Task Force of the Medical Dermatology Society and Society of Dermatology Hospitalists - 08/09/20

Doi : 10.1016/j.jaad.2020.06.051 
Omid Zahedi Niaki, MD a, , Milan J. Anadkat, MD b, Steven T. Chen, MD, MPH, MS-HPEd c, d, Lindy P. Fox, MD e, Joanna Harp, MD f, Robert G. Micheletti, MD g, Vinod E. Nambudiri, MD MBA a, Helena B. Pasieka, MD MS h, Michi M. Shinohara, MD i, Misha Rosenbach, MD g, Joseph F. Merola, MD, MMSc a, j
a Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 
b Division of Dermatology, Washington University in St. Louis School of Medicine, St Louis, Missouri 
c Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
d Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 
e Department of Dermatology, University of California, San Francisco, California 
f Department of Dermatology, Weill Cornell Medicine, New York, New York 
g Departments of Dermatology and Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 
h Department of Dermatology, Georgetown University School of Medicine, Medstar Washington Hospital Center, Washington, DC 
i Division of Dermatology, Department of Medicine, University of Washington, Seattle, Washington 
j Division of Rheumatology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 

Correspondence to: Omid Zahedi Niaki, MD, 41 Avenue Louis Pasteur, 319, Boston, MA 02115.41 Avenue Louis Pasteur, 319BostonMA02115

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Abstract

Dermatologists treating immune-mediated skin disease must now contend with the uncertainties associated with immunosuppressive use in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Although the risk of infection with many commonly used immunosuppressive agents remains low, direct data evaluating the safety of such agents in coronavirus disease 2019 (COVID-19) are scarce. This article reviews and offers guidance based on currently available safety data and the most recent COVID-19 outcome data in patients with immune-mediated dermatologic disease. The interdisciplinary panel of experts emphasizes a stepwise, shared decision-making approach in the management of immunosuppressive therapy. The goal of this article is to help providers minimize the risk of disease flares while simultaneously minimizing the risk of iatrogenic harm during an evolving pandemic.

Le texte complet de cet article est disponible en PDF.

Key words : autoimmune disease, COVID-19, dermatology-rheumatology, immunosuppression, immunosuppressive therapy, medical dermatology, SARS-CoV-2

Abbreviations used : CI, COVID-19, IL, MERS, OR, RR, SARS, SARS-CoV-2, TNF, URI, VTE


Plan


 Drs Rosenbach and Merola contributed equally to the manuscript development (cosenior authors).
 Funding sources: None.
 Conflicts of interest: Dr Niaki has participated in an advisory board for Eli Lilly. Dr Anadkat is currently serving as consultant for Boehringer-Ingelheim, NovoCure, and OnQuality and as an investigator for Biogen, Lutris, AnaptyxBio, Boehringer-Ingelheim, OnQuality, Norvartis, ChemoCentryx, UCB Biopharma, and XBiotech. Dr Shinohara has been a principle investigator for clinical trials (Actelion, Soligenix, MiRAGEN). Dr Rosenbach, has served as a consultant for Merck, aTyr, Processa, and Janssen and has received research support from Processa and salary support from JAMA Dermatology. Dr Merola is a consultant and/or investigator for Merck, Bristol-Myers Squibb, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres, and LEO Pharma. Drs Chen, Fox, Harp, Micheletti, Nambudiri, and Pasieka have no conflicts of interest to declare.
 IRB approval status: Not required.
 Reprints not available from the authors.


© 2020  American Academy of Dermatology, Inc.. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 83 - N° 4

P. 1150-1159 - octobre 2020 Retour au numéro
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