How Does COVID-19 Impact Biologic Treatments?

According to a small study published in The New England Journal of Medicine, findings suggest that the baseline use of biologics is not associated with worse COVID-19 outcomes. While this is good news, much more information is needed, and patients taking biologics should continue to follow guidelines from their doctors and the CDC to minimize risk to the virus.

The study’s research

The study involved established patients at New York University Langone Health in New York City who had known immune-mediated inflammatory disease, including psoriatic arthritis, psoriasis, rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease or related conditions. These patients also had or were highly suspected as having COVID-19 infection and were treating their conditions with biologics or Janus kinase (JAK) inhibitors.

From March 3 through April 3, 2020, the study compared a total of 86 patients who needed hospitalization with those who did not. Of those needing hospitalization, more had coexisting high blood pressure, diabetes or chronic obstructive pulmonary disease (COPD).

The study’s authors wrote: “Although our analysis was limited in sample size, our data reveal an incidence of hospitalization among patients with immune-mediated inflammatory disease that was consistent with that among patients with COVID-19 in the general population in New York City.”

More information needed

This study’s authors also wrote that a better understanding of COVID-19 patients taking biologics is needed to better guide doctors in the care of their patients, and my own doctor said this should not give patients a sense of invincibility.

Patients on biologics are encouraged to practice social distancing and proper hygiene, as well as follow other CDC guidelines. Patients should also report any illness to their doctor to see if stopping their biologic medication is in the patient’s best interest.

A global study

The COVID-19 Global Rheumatology Alliance is an online global registry for rheumatology patients who test positive for the virus and their providers. Its mission is to collect, analyze, and share information gathered to improve the care of patients with rheumatic disease through a physician-reported case registry of people with rheumatic diseases diagnosed with COVID-19.

In May 2020, it published results of a study with 600 patients from 40 countries. The study’s authors reported that most of the findings should give some reassurance to rheumatological patients who contract COVID-19:

• Patients taking biologics, NSAIDs and antimalarial drugs (like hydroxychloroquine) to treat their rheumatological diseases did not have a higher risk of hospitalization. In one specific category of biologics, anti-TNF, the indications of hospitalizations decreased.
• Patients taking moderate to high doses of glucocorticoids (like prednisone) for their rheumatological diseases were associated with a higher risk of hospitalization due to COVID-19.
• Most patients with rheumatological diseases or on immunosuppressive therapies recover from COVID-19.

Another expert weighs in

Dr. Stacie Bell, chief scientific and medical officer for the National Psoriasis Foundation (NPF), agreed that we need more data on this subject. However, she said because biologics are extremely targeted in a patient’s immune system and not blocking the entire system, many researchers think unless an individual becomes infected, it is not necessary to discontinue biologic treatment during the COVID-19 pandemic.

On the other hand, she said patients on general immunosuppressants may have a more difficult time fighting the virus because that medication is more generalized for the entire immune system. Dr. Bell encouraged individuals to refer to the NPF medical board recommendations for more details.

Stopping medications

If a patient does get infected, Dr. Bell said it is the NPF medical board’s recommendation to stop biologic treatment. If an individual is not infected, it is recommended that patients consult their doctors before stopping their treatment. Stopping biologic medications may worsen psoriatic disease, and if a patient flares, that could trigger other problems:

• Cardiovascular disease: According to NPF, research links psoriasis and psoriatic arthritis with an increased risk for cardiovascular disease. This is especially true for people with severe psoriasis. NPF says that treating your psoriatic disease reduces the risk for heart attack and stroke.
• Depression: Having psoriasis and psoriatic arthritis can take a mental toll on patients, giving them an increased risk of mental health issues. According to NPF, psoriatic arthritis patients have an even greater risk of developing depression than those who only have psoriasis. Treating your diseases can help alleviate symptoms of depression.
• Increased stress: Dr. Bell explained that this era of COVID-19 can put a lot of emotional stress on a patient, which can become even more severe during a disease flare.
• Restarting a biologic: Dr. Bell explained when a patient stops a biologic for a period of time, it may not be as effective when starting it back up. A patient may need to try another biologic, and insurance approval may take time.

Current research avenues

Here are some recent studies and ongoing research related to COVID-19, rheumatic disease and biologics:

• PsoProtect is an international psoriasis registry for health care providers to report COVID-19 outcomes in psoriasis patients. It aims to provide clinicians with information to assess the risk and COVID-19 treatments, as well as improve the understanding of how certain immune suppressing therapies and comorbidities affect patient outcomes.
• NPF’s Corrona Psoriasis Registry aims to advance medical research and improve patient care by providing questionnaires to patients and responses from doctors. Dr. Bell said COVID-19 questions will be added to the data collection for the registry soon.
• Other psoriatic disease studies and trials can be found at psoriasis.org/clinical-trials.