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Table 3 Recommendations for use of biologic therapy in psoriasis (after Nogueira et al. [78])

From: COVID-19 in adult patients with pre-existing chronic cardiac, respiratory and metabolic disease: a critical literature review with clinical recommendations

Management Issue Recommendation
Risk of severe COVID-19 Modest increased risk of URTI with TNF-alpha, IL-12/23, IL-23 and IL-17 blockers
Immunomodulatory drugs used for treatment of COVID-19 infection
Evaluate risk-to-benefit ratio for each patient
Do not blanket suspend biologic agents in all patients with psoriasis
Risk of flare-up of psoriasis Flare-ups may necessitate visit to clinic or hospital with risk of COVID-19 transmission
Suspend biologic agent only for proven COVID-19 patients until fully recovered
Consider screening for SARS-COV-2 in patients commencing biologic therapy
Risk of drug resistance Suspension and reintroduction of biologics may generate antibodies that affect response to drug, especially for TNF-alpha inhibitors
  1. URTI Upper respiratory tract infection, TNF Tumour necrosis factor, IL Interleukin