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
| 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.