National Psoriasis Foundation COVID-19 Task Force Guidance for Management of Psoriatic Disease During the Pandemic: Version 1. Gelfand, J., Armstrong, A., Bell, S., Anesi, G., Blauvelt, A., & Calabrese, C. et al. (2020). Journal Of The American Academy Of Dermatology. doi: 10.1016/j.jaad.2020.09.001
Alan Menter, MD
Texas Dermatology Associates
Dallas, Texas, United States
The task force involved in the development of the National Psoriasis Foundation (NPF) guidance on psoriasis and COVID-19 in the Journal of the American Academy of Dermatology (JAAD) comprised not only dermatologists (including pediatric dermatologists), but also rheumatologists, epidemiologists, infectious diseases and critical care specialists.
The publication featured 22 guidance statements – 9 of which had high consensus – issued by the NPF task force in 4 main topic areas:
- Effects of disease and its therapies impacting COVID-19 risks outcomes;
- Optimization of medical care;
- Patients advice on reducing COVID-19 exposure;
- What patients should do if they develop COVID-19.
Of interest, the 18 members of the task force met every 2 weeks for more than 3 months, to finalize their document and submit it for publication. It is important to note, that the statement relates to the more severe forms of psoriasis, i.e. moderate-to-severe psoriasis, with multiple comorbidities, that potentially could increase the risk of COVID-19 severity and even mortality.
One important limitation of the publication is the absence of global dermatologists and other experts, as well as psoriasis patients in the task force.
From my personal experience, at our psoriasis clinic in Dallas – where we have more than 4400 patients on biologic therapies – we had only 1 patient death due to the COVID virus. This patient was an elderly female on a TNF-α drug long term.
In summary, I believe the NPF document is of value, well written with one of the lead authors, Joel Gelfand, MD, also on the Board of the IPC.
Ulrich Mrowietz, MD
University of Kiel
Shared-decision making and adherence to evidence-based recommendations are central to the guidance provided by the physician task force in this article. In times when evidence is lacking, expert consensus is truly an appropriate measure to guide physicians and patients based on available information.
The list of guidance statements in the publication is long and aims to address most situations and frequently asked questions. Most of the statements are in perfect alignment with the recommendations given by the EuroGuiDerm guideline for the systemic treatment of psoriasis vulgaris and other national task forces.
The task force recommendations are supported by data from registries established when the pandemic started such as PsoProtect and CoronaBest. This source of knowledge is of particular importance as it covers the real-world evidence and with the increasing number of patients captured, is becoming a valid source for future recommendations. So far, PsoProtect includes nearly 500 patients mainly from Europe and as of Sept. 30, there is no evidence for a negative impact of COVID 19 in psoriasis patients treated with the full spectrum of systemic drugs.
A survey among 4,195 German psoriasis patients from the PsoBest/CoronaBest registry showed that >90% remained on their systemic therapy and did not consider psoriasis or drug treatment to be a risk factor for COVID-19. Only 0.45% were tested positive for SARS-CoV-2 and just a few discontinued drug treatments. However, patients felt that the level of information from physician about the pandemic needs to be improved (Augustin et al., submitted for publication).
Today it can be stated that psoriasis per se, is not a risk factor for SARS-CoV-2 infection or for a more severe COVID-19 disease course. As the coronavirus pandemic affects people in countries differently, there may be varying levels of comfort in counseling patients about the potential risk of psoriasis and/or systemic treatment and the susceptibility of SARS-CoV-2 infection or COVID-19. Therefore, it is understandable that as per the COVID situation in the US, the wording of the NPF guidance is cautious and aims to giving guidance regarding the entire spectrum of disease management.
In all, the statements from the NPF task force, highlight the need for shared-decision making between patient and physician to reach an informed consent regarding decisions about treatment and regular care in person or telemedicine to minimize the risk of infection. In the current situation, this is the best way to secure treatment adherence and trust between patients and physicians. If read carefully, the NPF guidance offers expert advice for virtually all frequently asked questions regarding the coronavirus pandemic with a focus on the situation of care in the US.