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3.
J Allergy Clin Immunol ; 149(3): 977-987.e14, 2022 03.
Article in English | MEDLINE | ID: covidwho-1356276

ABSTRACT

BACKGROUND: Primary (week 16) results from the ongoing phase 3, double-blind AD Up study (NCT03568318) demonstrate a positive benefit-risk profile for upadacitinib + topical corticosteroid (TCS) in patients with moderate-to-severe atopic dermatitis. OBJECTIVE: We evaluated the efficacy and safety of upadacitinib + TCS through 52 weeks. METHODS: Patients aged 12 to 75 years with chronic moderate-to-severe atopic dermatitis (≥10% of body surface area affected, Eczema Area and Severity Index [EASI] ≥16, Validated Investigator's Global Assessment for atopic dermatitis [vIGA-AD] ≥3, and Worst Pruritus Numerical Rating Scale [WP-NRS] score ≥4) were randomized 1:1:1 to once-daily upadacitinib 15 mg + TCS, upadacitinib 30 mg + TCS, or placebo (PBO) + TCS (rerandomized at week 16 to upadacitinib + TCS). Safety and efficacy, including proportion of patients experiencing ≥75% improvement in EASI (EASI-75), vIGA-AD of clear/almost clear with improvement ≥2 grades (vIGA-AD 0/1), and WP-NRS improvement ≥4, were assessed through week 52. Missing data were primarily handled by nonresponse imputation incorporating multiple imputation for missing values due to coronavirus disease 2019 (COVID-19). RESULTS: Of 901 patients, 300 were randomized to upadacitinib 15 mg + TCS, 297 to upadacitinib 30 mg + TCS, and 304 to PBO + TCS. For all end points, efficacy for upadacitinib 15 mg + TCS and upadacitinib 30 mg + TCS at week 16 was maintained through week 52. At week 52, the proportions of patients treated with upadacitinib 15 mg + TCS and upadacitinib 30 mg + TCS who experienced EASI-75 were 50.8% and 69.0%, respectively; 33.5% and 45.2%, respectively, experienced vIGA-AD 0/1; and 45.3% and 57.5%, respectively, experienced WP-NRS improvement ≥4. Upadacitinib + TCS was well tolerated through 52 weeks; no new important safety risks beyond the current label were observed. No deaths were reported; major adverse cardiovascular events and venous thromboembolic events were infrequent (≤0.2/100 patient-years). CONCLUSIONS: Results through 52 weeks demonstrate long-term maintenance of efficacy and a favorable safety profile of upadacitinib + TCS in patients with moderate-to-severe AD.


Subject(s)
Adrenal Cortex Hormones/administration & dosage , Dermatitis, Atopic/drug therapy , Dermatologic Agents/administration & dosage , Heterocyclic Compounds, 3-Ring/administration & dosage , Administration, Topical , Adolescent , Adrenal Cortex Hormones/adverse effects , Adult , Aged , Child , Dermatitis, Atopic/pathology , Dermatologic Agents/adverse effects , Double-Blind Method , Drug Therapy, Combination , Female , Heterocyclic Compounds, 3-Ring/adverse effects , Humans , Male , Middle Aged , Severity of Illness Index , Treatment Outcome , Young Adult
4.
J Drugs Dermatol ; 19(9): 889-892, 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-1231668

ABSTRACT

Early December 2019 witnessed an international outbreak of a novel coronavirus (COVID 19) designated severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Since then, a number of therapeutic molecules have been explored to have potential efficacy against the SARS-Cov-2 per se or its sequelae. There are no Food and Drug Administration specific therapies approved so far; however, numerous drugs based on varying levels of evidence, in vitro studies and compassionate drug trials are being established as therapeutic agents, especially drugs approved for previous emergence of the severe acute respiratory syndrome (SARS-CoV-1) and Middle east respiratory syndrome coronavirus (MERS-Cov). Numerous active clinical trials for COVID-19 with more than 150 drugs and products are under study. Needless to say, many dermatological drugs are being employed to mitigate this pandemic threat. We aim to review drugs with potential against SARS-Cov-2 widely used in dermatology practice. Additionally, rampant and overzealous use of these drugs as well as introduction of new molecules might lead to emergence of adverse effects associated with these agents. Dermatologists must be on lookout for any cutaneous adverse effects of these drugs. J Drugs Dermatol. 2020;19(9):889-892. doi:10.36849/JDD.2020.5323.


Subject(s)
Antiviral Agents/adverse effects , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Dermatologic Agents/adverse effects , Drug Eruptions/etiology , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/drug therapy , Adenosine Monophosphate/administration & dosage , Adenosine Monophosphate/adverse effects , Adenosine Monophosphate/analogs & derivatives , Alanine/administration & dosage , Alanine/adverse effects , Alanine/analogs & derivatives , Antiviral Agents/therapeutic use , Biological Products/administration & dosage , Biological Products/adverse effects , COVID-19 , Dermatologic Agents/therapeutic use , Drug Eruptions/epidemiology , Drug Eruptions/physiopathology , Drug-Related Side Effects and Adverse Reactions , Female , Humans , Incidence , Male , Pandemics , Prognosis , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/epidemiology
5.
J Cosmet Dermatol ; 20(7): 1969-1974, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1197160

ABSTRACT

BACKGROUND: Patients with acne vulgaris continue to present increasingly in dermatology outpatient clinics and seek treatment during the COVID-19 pandemic. As far as we know, the effect of isotretinoin on COVID-19 has not been studied before. AIM: We aimed to evaluate whether patients receiving oral isotretinoin are at increased risk of COVID-19 infection by comparing them with patients on topical treatment for acne vulgaris. METHODS: The data were collected retrospectively from a cohort of 267 acne vulgaris patients, who were under follow-up for acne vulgaris treatment during the pandemic period. RESULTS: Total of 227 patients (141 receiving isotretinoin treatment and 86 receiving topical treatment) were included of whom 29 patients had COVID-19 infection during acne vulgaris treatment. Fifteen (10.6%) patients were receiving oral isotretinoin and 14 (16.3%) were receiving topical acne treatment at the time of COVID-19 infection. The mean cumulative dose was 2340 ± 1988 mg at the time of COVID-19 infection. The mean elapsed time between the onset of isotretinoin treatment and positive PCR result for COVID-19 was 13.3 ± 10.3 weeks. Nine patients (64.3%) receiving isotretinoin treatment and 9 patients (60%) under topical treatment had loss of taste and smell during COVID-19 infection. Isotretinoin treatment was not found to be associated with a significant increased risk of getting COVID-19 (odds ratio, 0.671; 95% confidence interval, 0.247-1.823; P  = 0.434). CONCLUSION: As a conclusion, the results of this study encourage dermatologists and acne vulgaris patients to initiate oral isotretinoin treatment safely during the pandemic period.


Subject(s)
Acne Vulgaris , COVID-19 , Dermatologic Agents , Acne Vulgaris/drug therapy , Acne Vulgaris/epidemiology , Administration, Oral , Cohort Studies , Dermatologic Agents/adverse effects , Humans , Isotretinoin/adverse effects , Pandemics , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers
6.
Br J Dermatol ; 184(2): 296-303, 2021 02.
Article in English | MEDLINE | ID: covidwho-1066624

ABSTRACT

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic has spread, information about COVID-19 and skin disease or related biologics is still lacking. OBJECTIVES: To identify the association between COVID-19 and skin diseases or biologics. METHODS: A nationwide claim dataset relevant to COVID-19 in South Korea was analysed. This dataset included insurance claim data before and during COVID-19 treatment and clinical outcomes. Claim data related to skin diseases and relevant biologics were analysed to determine the association of COVID-19 with skin diseases and relevant biologics. RESULTS: The dataset contained a total of 234 427 individuals (111 947 male and 122 480 female) who underwent COVID-19 testing. Of them, 7590 (3·2%) were confirmed as having COVID-19, and 227 (3·0%) confirmed patients died. Among various skin diseases and biologics, no significant increase in the presence of specific skin diseases or exposure to biologics was observed in the COVID-19-positive group, even after adjusting for or matching covariates. The presence of skin diseases and exposure to biologics also did not seem to affect clinical outcomes including mortality. CONCLUSIONS: Underlying skin diseases did not appear to increase susceptibility to COVID-19 or mortality from COVID-19. Considering the risks and benefits, biologics for dermatological conditions might be continuously used during the COVID-19 pandemic.


Subject(s)
Biological Products/adverse effects , COVID-19/epidemiology , Dermatologic Agents/adverse effects , Skin Diseases/epidemiology , Adult , Age Factors , Aged , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/virology , COVID-19 Testing/statistics & numerical data , Cross-Sectional Studies , Disease Susceptibility , Female , Humans , Male , Middle Aged , Pandemics , Republic of Korea/epidemiology , Risk Factors , SARS-CoV-2/isolation & purification , Skin Diseases/drug therapy , Survival Analysis , Young Adult
7.
Dermatol Ther ; 33(6): e14516, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-917741

ABSTRACT

Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, there has been an open debate on the impact of biological drugs used in the treatment of psoriasis. To define whether patients under treatment with biologics suffer from increased morbidity and mortality from COVID-19, compared to psoriatic patients treated only with topical drugs, we designed an observational monocentric prevalence study recording the personal and clinical data of psoriatic patients, with focus on the presentation of signs and symptoms related to COVID-19 in the period of time ranging from 1 January 2020 to 31 May 2020. A total of 180 patients were enrolled into two groups: 100 patients in the topical therapy group and 80 patients in the biological therapy group. No statistically significant difference was found between the groups regarding the prevalence of COVID-19 infection and symptoms at a bivariable analysis with adjustment for confounders. In conclusion, psoriatic patients under treatment with biologics do not seem to be more susceptible to COVID-19 compared to other psoriatic patients and we suggest not interrupting treatment with biological drugs, even in areas suffering from active outbreaks of the disease.


Subject(s)
Biological Products/administration & dosage , COVID-19/epidemiology , Dermatologic Agents/administration & dosage , Immunosuppressive Agents/administration & dosage , Psoriasis/drug therapy , Adult , Aged , Biological Products/adverse effects , COVID-19/immunology , Dermatologic Agents/adverse effects , Drug Administration Schedule , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Italy/epidemiology , Male , Middle Aged , Prevalence , Prospective Studies , Psoriasis/epidemiology , Psoriasis/immunology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome
9.
Clin Dermatol ; 38(6): 731-733, 2020.
Article in English | MEDLINE | ID: covidwho-785353

ABSTRACT

In late 2019, the coronavirus disease 2019 (COVID-19) broke out in Wuhan and then spread over China, which greatly affected the medical practices and health care systems. With most of the hospital's outpatient services closed, the routine clinical diagnosis and treatment for patients with dermatomyositis has been disturbed. We conducted telephone follow-up for 52 patients to know the changes in the condition and the continuation of drug therapy and to ensure the continuity, safety, and effectiveness of the treatment of patients with dermatomyositis during COVID-19.


Subject(s)
COVID-19/epidemiology , Dermatologic Agents/therapeutic use , Dermatomyositis/drug therapy , Adult , Aged , China/epidemiology , Dermatologic Agents/adverse effects , Disease Outbreaks , Female , Humans , Male , Medication Adherence , Middle Aged , SARS-CoV-2 , Telemedicine
11.
Dermatol Ther ; 33(6): e14265, 2020 11.
Article in English | MEDLINE | ID: covidwho-742079

ABSTRACT

COVID-19 is a serious multisystem disease caused by severe acute respiratory syndrome coronavirus 2. Due to the COVID-19 crisis, that still keeps its impacts worldwide, numerous scheduled medical activities have been postponed and this interruption has a potential to modify the management of many cutaneous conditions including pemphigus. This narrative review aims to discuss the management of pemphigus in the era of COVID-19, considering the necessity to balance suitable pemphigus treatment with minimal risk of COVID-19-related mortality and morbidity. The data on the effect of treatments used for pemphigus on COVID-19 are limited. However, the evidence to manage patients properly is evolving and our knowledge is updated. Current expert recommendations include that patients with pemphigus should be informed clearly to avoid mismanagement and they should be monitored regularly for symptoms of COVID-19. Patients with mild disease can be managed with topical or intralesional corticosteroids, dapsone, or doxycycline. Systemic corticosteroids should be tapered to the lowest effective dose during the pandemic. Prednis(ol)one ≤10 mg/d can be continued in patients with COVID-19 while prednis(ol)one >10 mg/d may be reduced considering the activity of the disease. Conventional immunosuppressive therapies should only be discontinued in confirmed cases of COVID-19. Postponing rituximab treatment should be considered on a case by case basis. Intravenous immunoglobulin is not likely to increase the risk of infection and may be considered a safe option in patients with COVID-19. Given the psychological burden brought by COVID 19, online or face-to-face psychological support programs should be considered.


Subject(s)
COVID-19 , Dermatologic Agents/administration & dosage , Pemphigus/drug therapy , Dapsone/administration & dosage , Dermatologic Agents/adverse effects , Doxycycline/administration & dosage , Glucocorticoids/administration & dosage , Glucocorticoids/adverse effects , Humans , Immunoglobulins, Intravenous/administration & dosage , Immunoglobulins, Intravenous/adverse effects , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects
14.
Dermatol Ther ; 33(6): e13867, 2020 11.
Article in English | MEDLINE | ID: covidwho-679811

ABSTRACT

In patients with specific dermatologic disorders who are affected by new corona virus, we know little about disease course (underlying disease and new onset infection), and the most proper management strategies include both issues that are what this systematic review targets. Databases of PubMed, Scopus, Google Scholar, Medscape, and Centre of Evidence-Based Dermatology, coronavirus dermatology resource of Nottingham University searched completely up to May 15, 2020, and initial 237 articles were selected to further review and finally 9 articles (including 12 patients) entered to this study. From 12 patients with chronic underlying dermatologic disease treated with systemic therapies, only 1 patient required Intensive Care Unit admission, the others have been treated for mild-moderate symptoms with conventional therapies. The biologic or immunosuppressive/immunomodulator agents have been ceased during the course of disease. The course of coronovirus diseases 2019 (COVID-19) and its management was as similar as normal populations. Their underlying dermatologic disease were exacerbating from mild to moderate. Their treatment has been continued as before, after the symptoms improved. Exacerbation of patients underlying dermatologic disease was mild to moderate. Discontinuing the treatment in the acute period of COVID and the restart after recovery may prevent severe recurrence and disturbing cytokine storms in these patients.


Subject(s)
Biological Products/administration & dosage , COVID-19/therapy , Dermatologic Agents/administration & dosage , Immunosuppressive Agents/administration & dosage , Skin Diseases/drug therapy , Aged , Biological Products/adverse effects , COVID-19/diagnosis , COVID-19/immunology , Chronic Disease , Dermatologic Agents/adverse effects , Disease Progression , Drug Administration Schedule , Evidence-Based Medicine , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Male , Middle Aged , Recurrence , Risk Assessment , Risk Factors , Skin Diseases/diagnosis , Skin Diseases/immunology , Treatment Outcome
15.
Dermatol Ther ; 33(6): e13858, 2020 11.
Article in English | MEDLINE | ID: covidwho-679805

ABSTRACT

Coronavirus disease (COVID-19) is a highly contagious respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 outbreak has been declared a pandemic by the World Health Organization on March 2020. The pandemic has affected the management of psoriasis not only for those who are under treatment but also for those who are about to begin a new therapy to control their disease. An increasing number of studies in the current literature have focused on the relationship between psoriasis and COVID-19 from different perspectives. This narrative review includes searching the PubMed and Web of Science databases using the keywords "psoriasis," "psoriatic arthritis," "coronavirus," "COVID-19," and "SARS-CoV-2." The search was supplemented by manual searching of reference lists of included articles. A total of 11 relevant original investigations and 6 case studies was identified. The search was updated in May 2019. Due to the absence of randomized controlled trials, it is not likely to have a robust evidence-based approach to psoriasis management in the era of COVID-19. However, the current literature may provide some clues for safety considerations. Conventional immunosuppressive therapies such as methotrexate and cyclosporine, and anti-tumor necrosis factor agents should not be preferred due to increased risk of infection, especially in high-risk areas. The use of cyclosporine may pose additional risk due to the side effect of hypertension, which has been reported to be associated with susceptibility to severe COVID-19. Considering that the current literature has provided no conclusive evidence that biologics increase the risk of COVID-19, withdrawal of these agents should be reserved for patients with COVID-19 symptoms. The treatment approach should be personalized, considering the advantages and disadvantages for each case separately.


Subject(s)
COVID-19 , Immunosuppressive Agents/administration & dosage , Psoriasis/drug therapy , Biological Products/administration & dosage , Biological Products/adverse effects , Dermatologic Agents/administration & dosage , Dermatologic Agents/adverse effects , Humans , Hypertension/chemically induced , Hypertension/complications , Immunosuppressive Agents/adverse effects , Risk Factors
18.
Int J Dermatol ; 59(9): 1043-1056, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-625433

ABSTRACT

Recommendations were made recently to limit or stop the use of oral and systemic immunotherapies for skin diseases due to potential risks to the patients during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) COVID-19 pandemic. Herein, we attempt to identify potentially safe immunotherapies that may be used in the treatment of cutaneous diseases during the current COVID-19 pandemic. We performed a literature review to approximate the risk of SARS-CoV-2 infection, including available data on the roles of relevant cytokines, cell subsets, and their mediators in eliciting an optimal immune response against respiratory viruses in murine gene deletion models and humans with congenital deficiencies were reviewed for viral infections risk and if possible coronaviruses specifically. Furthermore, reported risk of infections of biologic and non-biologic therapeutics for skin diseases from clinical trials and drug data registries were evaluated. Many of the immunotherapies used in dermatology have data to support their safe use during the COVID-19 pandemic including the biologics that target IgE, IL-4/13, TNF-α, IL-17, IL-12, and IL-23. Furthermore, we provide evidence to show that oral immunosuppressive medications such as methotrexate and cyclosporine do not significantly increase the risk to patients. Most biologic and conventional immunotherapies, based on doses and indications in dermatology, do not appear to increase risk of viral susceptibility and are most likely safe for use during the COVID-19 pandemic. The limitation of this study is availability of data on COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Cytokine Release Syndrome/immunology , Dermatologic Agents/adverse effects , Disease Susceptibility/chemically induced , Pneumonia, Viral/epidemiology , Skin Diseases/drug therapy , Animals , Betacoronavirus/immunology , Biological Products/adverse effects , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Cytokine Release Syndrome/virology , Dermatology/methods , Dermatology/statistics & numerical data , Disease Models, Animal , Disease Susceptibility/immunology , Evidence-Based Medicine/methods , Evidence-Based Medicine/statistics & numerical data , Humans , Immunologic Factors/adverse effects , Mice , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Randomized Controlled Trials as Topic , Risk Assessment , SARS-CoV-2 , Severity of Illness Index , Skin Diseases/immunology
20.
Dermatol Ther ; 33(6): e13833, 2020 11.
Article in English | MEDLINE | ID: covidwho-598795

ABSTRACT

In the era of staggering speed in development of the novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we have reviewed the dermatologists' tools at hand for their utility (and potential risks) in patients affected by COVID-19. This review aims to shed light on the antiviral and proviral potential of drugs routinely used in dermatology to modulate COVID-19. The literature search included peer-reviewed articles published in the English language (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) from January 1990 to March 2020 and by reference lists of respective articles. Somewhat to our surprise, we have found that several of our drugs widely used in dermatology have antiviral potential. On the other hand, we also frequently use immunosuppressive drugs in our dermatologic patients that potentially pose them at increased risk for COVID-19.


Subject(s)
Antiviral Agents/administration & dosage , COVID-19/drug therapy , Dermatologic Agents/administration & dosage , Antiviral Agents/adverse effects , COVID-19/virology , Dermatologic Agents/adverse effects , Dermatology , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , SARS-CoV-2/isolation & purification
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