key: cord-282750-d9sb7o63
authors: Benhadou, F.; Del Marmol, V.
title: Improvement of SARS‐CoV2 symptoms following Guselkumab injection in a psoriatic patient
date: 2020-05-07
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.16590
sha: 
doc_id: 282750
cord_uid: d9sb7o63

We read with great interest the publication of Messina et al (1) reporting the first case of SARS‐CoV2 infection in a young patient of 32‐year‐old suffering from psoriasis and psoriatic arthritis treated by Guselkumab, a monoclonal antibody that targets specifically the p19 subunit of Interleukin (IL)‐23(2).The patient contracted the SARS‐CoV2 infection after a dinner with some friends but fortunately she developed very discrete symptoms including only mild fever and rhinorrhea. These findings support the potential role of IL‐23p19 inhibitors to counteract the « cytokine storm » triggered by the SARS‐CoV2 and which is potentially implicated in the severity of the symptoms (3).

arthritis treated by Guselkumab, a monoclonal antibody that targets specifically the p19 subunit of Interleukin (IL)-23 2 .The patient contracted the SARS-CoV2 infection after a dinner with some friends but fortunately she developed very discrete symptoms including only mild fever and rhinorrhea. These findings support the potential role of IL-23p19 inhibitors to counteract the « cytokine storm » triggered by the SARS-CoV2 and which is potentially implicated in the severity of the symptoms 3 . In some patients, this immune response against SARS-CoV2 is too

This article is protected by copyright. All rights reserved exaggerated which may cause acute respiratory distress syndrome and end organ failure but the precise mechanisms underlying the progression from mild to severe complications are still under investigation 3 . Interestingly, the cytokine profile associated with SARS-CoV2 infection severity is characterised by increased levels of tumor necrosis factor , IL-1, IL-2, IL-6, IL-7, granulocyte colony stimulating factor, interferon(IFN)-γ inducible protein 10, monocyte chemoattractant protein 1, and macrophage inflammatory protein 1-α among others 4 By targeting the IL-23p19 subunit, Guselkumab does not increase the risk for viral, bacterial or fungal infections among psoriasis patients 5 . IL-23 does not seem to be essential for controlling virus clearance but may play a role in the deleterious hyperinflammatory state associated to severe symptoms. Viral clearance seems to be more depending on other cytokines such as IL-15, type I IFN and IFN-γ 6 .

In addition to the case reported by Messina et al 1 , our present observation strongly supports the need to identify patients who will develop an hyperinflammation during the SARS-CoV2 infection and to recommend the use of existing and approved biologic therapies to taper down the immune reaction in order to reduce the mortality. Further investigations are required to validate Accepted Article

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