Full Guidelines—From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis - 18/07/24

Doi : 10.1016/j.jaad.2024.03.008

Warren A. James, MD ^a, Angela L. Rosenberg, BS ^a, Jashin J. Wu, MD ^b, Sylvia Hsu, MD ^c, April Armstrong, MD, MPH ^d, Elizabeth B. Wallace, MD ^e, Lara Wine Lee, MD, PhD ^f, Joseph Merola, MD, MMSc ^g, Sergio Schwartzman, MD ^h, Dafna Gladman, MD ⁱ, Clive Liu, MD ^j, John Koo, MD ^k, Jason E. Hawkes, MD, MS ^l, Soumya Reddy, MD ^m, Ron Prussick, MD, FRCPC ⁿ, Paul Yamauchi, MD ^o, Michael Lewitt, MD ^p, Jennifer Soung, MD ^q, Jeffery Weinberg, MD ^r, Mark Lebwohl, MD ^r, Brad Glick, DO, MPH ^s, Leon Kircik, MD ^t, Seemal Desai, MD ^u, Steven R. Feldman, MD, PhD ^a,^v,^w,^x, Mallory L. Zaino, MD ^a,^⁎
^a Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
^b Department of Dermatology, University of Miami Miller School of Medicine, Miami, Florida
^c Department of Dermatology, Temple University School of Medicine, Philadelphia, Pennsylvania
^d Department of Dermatology, Keck School of Medicine at University of Southern California, Los Angeles, California
^e Department of Dermatology, Cherry Hills Dermatology, Englewood, Colorado
^f Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina
^g Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
^h Department of Dermatology, 72nd Street Medical Associates, New York, New York
ⁱ Department of Dermatology, University of Toronto, Toronto, Canada
^j Department of Dermatology, Bellevue Dermatology, Bellevue, Washington
^k Department of Dermatology, University of California, San Francisco Medical Center, San Francisco, California
^l Department of Dermatology, University of California, Davis, Rocklin, California
^m Department of Dermatology, New York University Grossman School of Medicine, New York, New York
ⁿ Department of Dermatology, Washington Dermatology Center, Frederick, Maryland
^o Department of Dermatology, Dermatology Institute & Skin Care Center, Santa Monica, California
^p Department of Dermatology, Illinois Dermatology Institute, LLC, Chicago, Illinois
^q Department of Dermatology, Southern California Dermatology, Santa Ana, California
^r Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
^s Department of Dermatology, Glick Skin Institute, Margate, Florida
^t Department of Dermatology, Physicians Skin Care, Louisville, Kentucky
^u Department of Dermatology, Innovative Dermatology, Plano, Texas
^v Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, North Carolina
^w Department of Pathology, Wake Forest School of Medicine, Winston-Salem, North Carolina
^x Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina

^∗Correspondence to: Mallory L. Zaino, MD, Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157.Center for Dermatology ResearchDepartment of DermatologyWake Forest School of MedicineMedical Center BlvdWinston-SalemNC27157

Abstract

Background

Systemic immunomodulatory agents are indicated in the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Perioperative use of these medications may increase the risk of surgical site infection (SSI) and complication.

Objective

To evaluate the risk of SSI and complication in patients with chronic autoimmune inflammatory disease receiving immunomodulatory agents (tumor necrosis factor-alfa [TNF-α] inhibitors, interleukin [IL] 12/23 inhibitor, IL-17 inhibitors, IL-23 inhibitors, cytotoxic T-lymphocyte–associated antigen-4 costimulator, phosphodiesterase-4 inhibitor, Janus kinase inhibitors, tyrosine kinase 2 inhibitor, cyclosporine (CsA), and methotrexate [MTX]) undergoing surgery.

Methods

We performed a search of the MEDLINE PubMed database of patients with chronic autoimmune inflammatory disease on immune therapy undergoing surgery.

Results

We examined 48 new or previously unreviewed studies; the majority were retrospective studies in patients with rheumatoid arthritis and inflammatory bowel disease.

Conclusion

For low-risk procedures, TNF-α inhibitors, IL-17 inhibitors, IL-23 inhibitors, ustekinumab, abatacept, MTX, CsA, and apremilast can safely be continued. For intermediate- and high-risk surgery, MTX, CsA, apremilast, abatacept, IL-17 inhibitors, IL-23 inhibitors, and ustekinumab are likely safe to continue; however, a case-by-case approach is advised. Acitretin can be continued for any surgery. There is insufficient evidence to make firm recommendations on tofacitinib, upadacitinib, and deucravacitinib.

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Key words : abatacept, acitretin, apremilast, biologic, cyclosporine, IL-12/23 inhibitor, IL-17 inhibitor, IL-23 inhibitor, immunosuppressant, methotrexate, perioperative, psoriasis, psoriatic arthritis, tofacitinib, tumor necrosis factor-alfa inhibitors

Abbreviations used : ADA, CI, CsA, IBD, IFX, IL, IVS, JAK, MTX, OR, PsA, RA, SSI, TNF-α

Plan

Introduction

Methods

Results

TNF-α inhibitors and ustekinumab: Evidence from psoriasis

TNF-α inhibitors: Evidence from RA

TNF-α inhibitors and ustekinumab: Evidence from IBD

Abatacept: Evidence from RA

Secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab

MTX: Evidence from RA

MTX: Evidence from IBD

CsA: Evidence from IBD

Janus kinase inhibitors: Evidence from IBD

	Dr James and Author Rosenberg contributed equally to this article.
	Funding sources: None.
	Patient consent: Not applicable.
	IRB approval status: Not applicable.

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Vol 91 - N° 2

P. 251.e1-251.e11 - août 2024 Retour au numéro

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Full Guidelines—From the Medical Board of the National Psoriasis Foundation: Perioperative management of systemic immunomodulatory agents in patients with psoriasis and psoriatic arthritis - 18/07/24

Abstract

Background

Objective

Methods

Results

Conclusion

Plan

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