Q&A: Effect of biologic treatment on COVID-19 infection

Treating psoriasis and psoriatic disease during the COVID-19 pandemic has proven to be challenging for many providers.

As new data emerge, the use of biologic treatments has been reviewed in order to further understand their effect on COVID-19 transmission or severity. Those with psoriatic disease also often have comorbidities that can increase the severity of the virus.

Healio Psoriatic Disease spoke with Jerry Bagel, MD, MS, of the Psoriasis Treatment Center of Central New Jersey, about his experience with treating psoriasis during the global pandemic, especially in a state where COVID has seen some of its biggest surges.

Q: Now that there is a few more months of data from COVID-19, have patients on biologic treatments for psoriasis or psoriatic disease shown any additional risk factors for contracting COVID-19?

A: Throughout the COVID pandemic, the Psoriasis Treatment Center of New Jersey has treated 1,500 patients with moderate to severe psoriasis and/or psoriatic arthritis. This group includes 1,000 on FDA-approved biologic therapy, 250 on phototherapy, 150 in clinical trials and 100 on systemic therapy. Bear in mind, in New Jersey, 3.75% of the population has tested positive for COVID, and of that group, 5% has died. At our center, 10 patients on biologics have tested positive, with none of them being hospitalized. One clinical trial patient was hospitalized with pneumonia, recovered and resumed the clinical trial, and one patient on phototherapy died of COVID; therefore, we have not seen an increased frequency of morbidity/hospitalization/mortality in our biologically treated patients.

Q: What additional risk factors do patients have in terms of contracting the virus or experiencing more severe symptoms?

A: Psoriatic comorbidities are my major concern in regard to biologics and COVID-19 infection. These are the same concerns I have for patients who are not on a biologic agent. These include obesity, advanced age, COPD, asthma, a history of cigarette smoking, alcoholism, diabetes, a history of malignancy and a history of recurrent infections.

Q: Has prescribing biologic treatments changed in the time of COVID-19, and if so, how?

A: Almost all biologic agents during clinical trials have tested vaccine response while the patient has been on the biologic for at least 12 weeks. Janssen evaluated 200 psoriatic patients on Stelara (ustekinumab) for more than a year compared with 200 psoriatic patients who were not on any biologic. They then administered tetanus vaccine, and the antibody response in both groups was about 95%, showing that Stelara, a biologic agent, did not interfere in viral surveillance and antibody production.

Q: How can psoriasis specialists talk with their patients about biologic treatments to discuss the risks and benefits?

A: Many patients are reluctant to go on a biologic during the pandemic. About 30% of our patients discontinued their biologic at the beginning of the pandemic and are now, as a tribute to the efficacy of these drugs, 6 months later coming into the center because they are flaring — not severe in most cases — to resume therapy. I often discuss with my patients that some biologic agents are being tested in COVID treatments to help diminish the inflammatory cytokine storm. I discuss how psoriasis is an inflammatory condition and how COVID kills by increasing inflammation in the lungs. Biologics mechanistically decrease inflammation, so it may be beneficial for their psoriasis and could also decrease COVID-induced inflammation.