What are the risks for switching biologics during the COVID-19 pandemic?
Brad Glick, DO, FAAD: I think one has to ask the questions first, 'Is it a primary failure, a drug that has just been unsuccessful? Has the drug been working, and now it's not—so kind of what we call secondary failure or loss of response down the road, if you will? Or is the patient having an adverse reaction?' What are the downsides of switching during the pandemic? I think it's really dictated by one factor, and that is if the patient is well, biologic therapies should not be disrupted during the pandemic. And I think that we have some pretty nice guidelines and guidance from the National Psoriasis Foundation, also in conjunction with the COVID-19 Task Force of the American Academy of Dermatology. So, it's very situational.
But if someone is not doing well, and their skin is flaring, and we need to change their biologic—whether there's a secondary failure or a primary failure, just not responding in a short period of time—then it's perfectly fine to change the biologic. Obviously, what we don't want to have happen is for someone to develop an infection while on a biologic therapy, but we counsel patients before putting them on any immunosuppressive therapy, including biologics before placing them on such an agent. And throughout the pandemic, we've told our patients clearly, even those who we felt were severe enough to place them on a systemic therapy like a biologic, just like we do with any other infection, that should they develop any symptoms of an infection, including those symptoms that would worry us about COVID-19—not just the respiratory symptoms and the fever, but for instance, one of the hallmarks of COVID-19 we've learned in this last year, which is a loss of taste—stop the biological right away. Of course, notify us immediately of such symptoms, contact your general physician as well.
But in my opinion, I don't see a lot of downside in switching if there is a specific necessity to switch, and I don't know that the pandemic specifically impairs that specifically where biologics are concerned, because they are highly targeted therapies, particularly the newer generation therapies like the interleukin 17 blockers and the interleukin 23 blockers.