








key: cord-333684-j1sg46w9
authors: Filippi, Federica; Loi, Camilla; Evangelista, Valeria; Bardazzi, Federico
title: COVID‐19 era: A chance to learn something new about monitoring psoriatic patients in biological therapy
date: 2020-06-10
journal: Dermatol Ther
DOI: 10.1111/dth.13805
sha: 
doc_id: 333684
cord_uid: j1sg46w9

nan

The novel coronavirus (severe acute respiratory syndrome coronavirus: SARS-CoV-2) and the related disease (Coronavirus disease-19: COVID-19) emerged in China in December 2019 and rapidly spread over the continents in a matter of months; it has dramatically changed not only our daily life, but also our daily dermatological practice 1,2 . However, these forced changes have provided us food for thought.

About 750 psoriatic patients assuming biological therapy currently refer to our psoriasis outpatient service, in Sant'Orsola-Malpighi University Hospital, Bologna (Italy), with an average of 80 patients visited weekly. In the screening and monitoring of psoriatic patients, we follow the latest Italian guidelines 3 : blood tests (full blood count, creatinine and electrolytes, liver function tests, serum lipids, fasting glucose) as well as psoriasis disease severity assessment and general physical examination should be performed at baseline and periodically afterwards, on average every 3-4 months, based on clinical judgement, in particular extension of the disease (body surface area, nail involvement, critical areas localization), diagnosis of arthropatic psoriasis, comorbidities and other associated symptoms.

In consequence of the COVID-19 pandemic and in accordance with the ministerial decree of March 9, 2020 (GU Serie Generale n.62 09-03-2020), all non-urgent dermatological consultations were suspended in our country, so face-to-face visits decreased markedly in favour of the now familiar This article is protected by copyright. All rights reserved.

"teledermatology" 4,5 . On March 13, 2020, the Italian Medicines Agency (AIFA) allowed the automatic renewal of all expiring therapeutic plans for biologic drugs for 90 days, to prevent patients from coming to the hospital only to renew their prescription 6 . Non-urgent blood tests were also suspended, including monitoring in psoriatic patients undergoing biological therapy 7 .

This was the situation until May 4, 2020, when "Step 2" was implemented: a slow reactivation of the activities and a soft but important relaunch for Italy 8 . Scheduled visits were re-established, and the retrieval of the missed follow-up visits has begun. However, blood tests are still performed only in selected cases, to avoid hospital overcrowding.

Considering the last 2 months, 250 of the approximately 400 patients to retrieve were visited, 180 of whom had been in biological therapy with the same drug for at least 1 year and were considered responders. Out of these 180 patients, 6 had self-interrupted the treatment, fearing an increased risk of infection; 10/180 responders had a slight worsening of the disease (from 10% to 25% worsening of PASI compared to the previous examination, about 3 months earlier); in the remaining 170/180 patients, psoriasis remained well controlled (less than 10% worsening of PASI compared to the previous examination, about 3 months earlier). In addition, none of the patients had been able to undergo the monitoring blood tests.

So far, the disease appears to have been well-controlled in most of our patients under biological therapy, despite the undeniable period of perceived stress, income loss and outdoor activity restriction, partly thanks to the many telephone consultations we provided during the lockdown.

Therefore, telemedicine has proven to be a successful method in monitoring patients in "welltested" biological therapy, and it could be considered a valid option for many months to come, as This article is protected by copyright. All rights reserved. social distancing will remain the most effective safeguard, probably until the introduction of a vaccine.

For the same reason, blood tests will be performed less frequently than the usual 3-4 months; we will be able to tell in a few months if this forced procrastination will have had negative consequences on the outcome of our patients. If this is not so, it could be the starting point for a further lengthening of the monitoring time of psoriatic patients considered responders to biological therapy.

Active implications for dermatologists in "SARS-CoV-2 era": Personal experience and review of literature

The covid-19 outbreak in Italy: preventive and protective measures adopted by the dermatology unit of bologna university hospital

Italian guidelines on the systemic treatments of moderate-to-severe plaque psoriasis

Teledermatologic monitoring for chronic cutaneous autoimmune diseases with smartworking during Covid-19 emergency in a tertiary center in Italy

Store-and-forward Teledermatology in the era of COVID-19: A Pilot Study

Transitional measures concerning the extension of the AIFA treatment plans for the containment and management of the epidemiological emergency from Covid-19

Ulteriori disposizioni attuative del decretolegge 23 febbraio 2020, n. 6, recante misure urgenti in materia di contenimento e gestione dell'emergenza epidemiologica da COVID-19, applicabili sull

Ulteriori disposizioni attuative del decretolegge 23 febbraio 2020



