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Maynard N, Armstrong AW. The Impact of Immune-Modulating Treatments for Dermatological Diseases on the Risk of Infection with SARS-CoV-2 and Outcomes Associated with COVID-19 Illness. CURRENT DERMATOLOGY REPORTS 2023; 12:45-55. [PMID: 37304177 PMCID: PMC10068706 DOI: 10.1007/s13671-023-00385-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 04/05/2023]
Abstract
Purpose of Review Immune-modulating treatments are used in dermatology for a variety of conditions. The authors aim to review the data regarding the safety of these treatments during the COVID-19 pandemic, namely the risk of infection with SARS-CoV-2 and the outcomes associated with COVID-19-related illness. Recent Findings Several large-scale studies found no increased risk of COVID-19 infection for patients on TNF-α inhibitors, IL-17 inhibitors, IL-12/23 inhibitors, IL-23 inhibitors, dupilumab, and methotrexate. They also found that these patients did not have worse outcomes when infected with COVID-19. The data regarding JAK inhibitors, rituximab, prednisone, cyclosporine, mycophenolate mofetil, and azathioprine are more mixed. Summary Based on current research and guidelines from the American Academy of Dermatology and the National Psoriasis Foundation, dermatology patients on immune-modulating therapies can continue treatment during the COVID-19 pandemic when they are not infected with SARS-CoV-2. For patients who have COVID-19, guidelines encourage individualized assessment of the benefits and risks of continuing or temporarily withholding treatment.
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Affiliation(s)
- Nicole Maynard
- Keck School of Medicine of USC, 1975 Zonal Avenue, KAM 510, MC 9034, Los Angeles, CA 90089 USA
| | - April W. Armstrong
- Keck School of Medicine of USC, 1975 Zonal Avenue, KAM 510, MC 9034, Los Angeles, CA 90089 USA
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Gisondi P, Geat D, Bellinato F, Girolomoni G. Use of biologics during the COVID-19 pandemic: lessons learned from psoriasis. Expert Opin Biol Ther 2022; 22:1521-1529. [PMID: 35930356 DOI: 10.1080/14712598.2022.2110467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Given the increased infectious risk associated with biologics, particularly with TNFα inhibitors, concerns were raised over the safety of these agents in relation to SARS-CoV-2 infection. Furthermore, the impact of biologics on SARS-CoV-2 vaccination was questioned. AREAS COVERED In this review, studies conducted on patients with moderate to severe plaque psoriasis treated with biologics during the COVID-19 pandemic have been analyzed, including 1) the safety of biologics in psoriatic patients in terms of increased risk and/or worse outcome of SARS-CoV-2 infection; and 2) whether biologic agents could affect the safety and response to SARS-CoV-2 vaccines in psoriatic patients. EXPERT OPINION Current evidence indicates that the use of biologics in psoriatic patients does not seem to be associated with an increased COVID-19 infection risk or worse outcome, with TNFα inhibitors being even protective of severe COVID-19 relative to other treatments or no treatment at all. Furthermore, biologic treatment does not seem to have a significant impact on the response and safety of vaccines in patients with psoriasis treated with biologics. However, uncertainty remains given the limitations of current studies which are often of short duration, limited sample sizes and do not stratify on specific biologic classes.
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Affiliation(s)
- Paolo Gisondi
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Davide Geat
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Francesco Bellinato
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
| | - Giampiero Girolomoni
- Department of Medicine, Section of Dermatology and Venereology, University of Verona, Verona, Italy
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Akiyama S, Hamdeh S, Sakamoto T, Suzuki H, Tsuchiya K. The Feasibility, Safety, and Long-term Outcomes of Endoscopic Submucosal Dissection for Colorectal Neoplasia in Patients With Inflammatory Bowel Disease: A Systematic Review and Meta-analysis. J Clin Gastroenterol 2022:00004836-990000000-00042. [PMID: 35943418 DOI: 10.1097/mcg.0000000000001740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/21/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND Evidence regarding the utility of endoscopic submucosal dissection (ESD) for neoplasia in patients with inflammatory bowel disease (IBD) is limited. This meta-analysis aims to understand the feasibility, safety, and long-term outcomes of ESD in IBD patients. METHODS Electronic databases were searched for observational and case-controlled studies. Primary endpoints were en bloc resection and margin-negative resection of neoplastic lesions. Secondary endpoints included procedure-related bleeding and perforation, local recurrence, and metachronous neoplasia. RESULTS We analyzed 25 studies with a total of 585 neoplastic lesions in 552 patients. The rates of en bloc resection and margin-negative resection were 0.88 [95% confidence interval (CI) 0.82-0.92] and 0.78 (95% CI 0.72-0.83), respectively. Meta-regression analysis showed longer disease duration was significantly associated with the higher rate of en bloc resection. The rates of procedure-related bleeding and perforation were 0.080 (95% CI 0.057-0.11) and 0.055 (95% CI 0.038-0.081), respectively. The rates of local recurrence and metachronous neoplasia were 0.008 events/person-year (95% CI 0.002-0.013) and 0.031 event/person-year (95% CI 0.016-0.046), respectively. Meta-analysis of case-controlled studies found no significant differences in the endpoints between IBD patients treated by ESD and those treated by endoscopic mucosal resection, or non-IBD patients treated by ESD. CONCLUSIONS ESD is a feasible and safe procedure to remove neoplastic lesions in IBD patients. Given there is a considerable risk of metachronous neoplasia development, postoperative surveillance colonoscopy with an appropriate consultation with surgeons is essential to monitor not only local recurrence but also neoplastic changes in the remaining colon.
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Affiliation(s)
- Shintaro Akiyama
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | - Shadi Hamdeh
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas, Lawrence, KS
| | - Taku Sakamoto
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | - Hideo Suzuki
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, University of Tsukuba, Ibaraki, Japan
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Fukuda S, Akiyama S, Tarakji A, Hamdeh S, Suzuki H, Tsuchiya K. Prevalence and clinical features of patients with autoimmune pancreatitis and inflammatory bowel disease: A systematic review and meta-analysis. J Gastroenterol Hepatol 2022; 37:1474-1484. [PMID: 35596263 DOI: 10.1111/jgh.15894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/15/2022] [Accepted: 05/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Autoimmune pancreatitis (AIP) and inflammatory bowel disease (IBD) are categorized into immune-mediated inflammatory disorders (IMIDs). While AIP is a pancreato-biliary IMID with an increased incidence and prevalence among patients with IBD, its features are still unclear. This systematic review and meta-analysis aims to assess the prevalence and clinical characteristics of AIP-IBD patients. METHODS Electronic databases were searched to identify observational studies assessing AIP and IBD. The primary outcome was the prevalence of IBD among AIP patients, and vice versa. Secondary outcomes included clinical findings and outcomes of each IMID in AIP-IBD patients. The pooled rate of each outcome was determined using a random effects model. RESULTS For primary outcomes, 40 observational studies with 4031 AIP patients were included and the pooled prevalence of IBD was 10.5% (95% CI 7.2-15.0%). Meanwhile, five studies with 10,551 IBD patients were included and the pooled prevalence of AIP was 0.6% (95% CI 0.2-1.9%). For secondary outcomes, 53 observational studies with 469 AIP-IBD patients were assessed. The rates of type 2 AIP and ulcerative colitis were 79.2% (95% CI 69.1-86.6%) and 74.8% (95% CI 68.2-80.4%), respectively. We also demonstrated AIP-IBD patients were at a significant increased risk of AIP recurrence and colectomy compared with patients with either AIP or IBD (RR = 1.9, 95% CI 1.1-3.1 and P = 0.014 and RR = 3.7, 95% CI 1.9-6.9, P < 0.001, respectively). CONCLUSIONS Our meta-analysis reported the prevalence of AIP-IBD patients and demonstrated patients with both IMIDs had a high risk of poor outcomes.
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Affiliation(s)
- Soma Fukuda
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shintaro Akiyama
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Ahmad Tarakji
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas, Lawrence, Kansas, USA
| | - Shadi Hamdeh
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas, Lawrence, Kansas, USA
| | - Hideo Suzuki
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Akiyama S, Hamdeh S, Murakami N, Cotter TG, Suzuki H, Tsuchiya K. Pregnancy and neonatal outcomes in women receiving calcineurin inhibitors: A systematic review and meta-analysis. Br J Clin Pharmacol 2022; 88:3950-3961. [PMID: 35593302 DOI: 10.1111/bcp.15414] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/24/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
AIM Calcineurin inhibitors (CNIs) are often used for solid organ transplantation recipients or patients with immune-mediated diseases. This systematic review and meta-analysis aims to understand how CNIs affect pregnancy and neonatal outcomes. METHODS Electronic databases were searched for observational studies assessing pregnancy and neonatal outcomes in CNI-treated patients. The pooled rate of each outcome was determined. Meta-regression was conducted to identify contributing factors to the outcomes. RESULTS We analyzed 98 studies with a total of 5,355 pregnancies in 4,450 CNI-treated patients. The pooled rates of live birth and spontaneous abortion were 82.1% (95% CI 76.7%-86.4%) and 11.7% (95% CI 8.7%-15.5%), respectively. The rates of preterm delivery (33.2%, 95% CI 29.2%-37.5%), low birth weight (35.8%, 95% CI 27.7%-44.8%), and preeclampsia (13.5%, 95% CI 9.4%-19.2%) were 3-4 times higher than the rates of general population. Nearly half of the CNI-treated patients required C-section (43.5%, 95% CI 36.9%-50.3%). The rates of stillbirth, neonatal, and maternal death were 4.2% (95% CI 2.8%-6.2%), 2.9% (95% CI 1.8%-4.8%), and 2.3% (95% CI 1.3%-4.1%), respectively. Meta-regression showed preeclampsia was significantly associated with the risks of preterm delivery and low birth weight. Older maternal age, pre-pregnancy hypertension, and cyclosporine use increased the risk of preeclampsia. CONCLUSION Given the higher mortalities in CNI-treated patients and their children than the general averages, their pregnancy is considered high risk. The risks of preterm delivery and low birth weight were primarily attributed to preeclampsia. Since pre-pregnancy hypertension increased its risk, an appropriate preconception blood pressure management may improve their outcomes.
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Affiliation(s)
- Shintaro Akiyama
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Shadi Hamdeh
- Department of Internal Medicine, Division of Gastroenterology, Hepatology and Motility, University of Kansas, KS, USA
| | - Naoka Murakami
- Division of Renal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas G Cotter
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, TX, USA
| | - Hideo Suzuki
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Kiichiro Tsuchiya
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Jones ME, Kucharik AH, Pourali SP, Rajkumar JR, Gutierrez Y, Yim RM, Armstrong AW. The Use of Biologics During the COVID-19 Pandemic. Dermatol Clin 2021; 39:545-553. [PMID: 34556244 PMCID: PMC8166518 DOI: 10.1016/j.det.2021.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, there has been considerable discussion regarding the use of biologics in patients with inflammatory skin conditions, such as psoriasis, hidradenitis suppurativa, and atopic dermatitis. This article discusses clinical trial data, real-world evidence, and guidelines and recommendations for biologics that inhibit tumor necrosis factor, interleukin (IL)-12/23, IL-17, IL-23, and IL-4/13 during the COVID-19 pandemic. Across these inflammatory skin conditions, existing data generally suggest that biologics do not seem to increase the risk of COVID-19 infection or worsen COVID-19 outcomes. The impact of biologics on COVID-19 is an area of active exploration.
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Affiliation(s)
- Madison E Jones
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Alison H Kucharik
- Florida Atlantic University Charles E Schmidt College of Science, 777 Glades Road BC-71, Boca Raton, FL 33431, USA
| | - Sarah P Pourali
- Vanderbilt University School of Medicine, 1161 21st Ave S # D3300, Nashville, TN 37232, USA
| | - Jeffrey R Rajkumar
- Univeristy of Illinois College of Medicine at Chicago, 1853 W Polk St, Chicago, IL 60612, USA
| | - Yasmin Gutierrez
- University of California Riverside School of Medicine, 92521 Botanic Gardens Dr, Riverside, CA 92507, USA
| | - Rebecca M Yim
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - April W Armstrong
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
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Shin DB, Syed MN, Gelfand JM. Commentary. J Am Acad Dermatol 2021; 84:e161-e162. [PMID: 33039482 PMCID: PMC7543884 DOI: 10.1016/j.jaad.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/01/2020] [Accepted: 10/02/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Daniel B Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Maha N Syed
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Systematic review: IL-12/23 or IL-23 antagonists and RTIs or ILD. REACTIONS WEEKLY 2020. [PMCID: PMC7453847 DOI: 10.1007/s40278-020-82554-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
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