Response: Is the Coronavirus (COVID-19) Pandemic an Indication to Temporarily Modify Dermatological Management Plans?

摘要

We should all be concerned about the impact of COVID-19 on our patients and should examine the potential impact of the drugs we use on susceptibility to infection and severity of infection. We do not believe that we can lump all drugs together under the category of "immunosuppressive." In fact, we run the risk of harming our patients if we tell them to stop all biologic therapies. Dupilumab is the perfect example. It should not be called an immunosuppressive agent and in fact, in the package insert it is referred to as an immunotherapy. The word "immunosuppressive" (or the word "viral") does not appear in its package insert. In a study from our lab, dupilumab reduced the elevated levels of IL-4 found in lesional skin of patients with atopic dermatitis to levels found in non-lesional skin, and there is no evidence that it reduces cytokines to levels below normal.1 Moreover, many of our patients with atopic dermatitis also have asthma, which should be considered a risk factor for severe COVID-19 infection, and asthma is also treated effectively by dupilumab. Withholding that treatment may be detrimental. Omalizumab is also used to treat asthma and similar concerns should be considered.