COVID-19 pandemija i stopa vakcinacije kod obolelih od psorijaze lečenih biološkim lekovima: iskustvo jednog centra
Sažetak
Uvod/Cilj. Psorijaza je hronična, genetski uslovljena bolest, posredovana imunskim mehanizmima, koja se manifestuje pojavom eritematoznih plakova sa skvamom. Lečenje podrazumeva konvencionalnu i biološku terapiju. Bolest izazvana korona virusom 2019. (coronavirus disease 2019 – COVID-19) izazvala je zabrinutost za obolele od psorijaze koji se leče imunosupresivnim lekovima, posebno biološkom terapijom. Iako na početku pandemije nije bilo dovoljno podataka o efikasnosti i bezbednosti vakcine protiv COVID-19 kod obolelih od psorijaze na biološkoj terapiji, Nacionalna fondacija za psorijazu (Sjedinjene Američke Države) preporučila je vakcinaciju protiv COVID-19 kod ovih bolesnika. Cilj studije bio je da se ispita uticaj COVID-19 na kliničku sliku i kvalitet života obolelih od psorijaze koji su lečeni biološkom terapijom, kao i da se ispita efikasnost biološke terapije tokom pandemije. Metode. Retrospektivna studija preseka sprovedena je na Klinici za dermatologiju i venerologiju Univerzitetskog kliničkog centra Srbije, u periodu od marta 2020. do januara 2022. godine. Podaci su prikupljeni iz medicinske dokumentacije tokom konsekutivne hospitalizacije obolelih od psorijaze lečenih biološkom terapijom. Rezultati. Istraživanje je obuhvatilo 181 bolesnika obolelih od psorijaze podeljenih u dve grupe. Bolesnici iz obe grupe lečeni su različitim biološkim lekovima (ustekinumab kod 63,0% i sekukinumab kod 37,0% bolesnika). Kod njih je postignuto značajno poboljšanje kliničke slike, koja je praćena tokom dve godine [Psoriasis Area and Severity Index (PASI) pre lečenja: 14,1 (0–50,5) i posle lečenja: 1,2 (0–49,7), p < 0,001], i kvaliteta života [Dermatology Life Quality Index (DLQI) pre lečenja: 15,0 (0–34) i posle lečenja: 0 (0–28), p < 0,001]. Zbog nezadovoljavajućeg terapijskog odgovora kod 4 (2,2%) bolesnika, sekukinumab je zamenjen ustekinumabom. Vakcinu protiv COVID-19 primilo je 53,0% bolesnika, ali je sve tri doze primilo samo 20,4% bolesnika. Infekcija virusom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) potvrđena je kod 64 (35,4%) bolesnika a 68,0% od ukupnog broja zaraženih obolelo je pre prve doze vakcine. Terapija biološkim lekovima bila je odložena zbog SARS-CoV-2 infekcije kod 52 (28,7%) bolesnika, od kojih je 11 (21,2%) imalo pogoršanje psorijaze. Zaključak. Stopa vakcinacije obolelih od psorijaze koji su primali biološku terapiju bila je jedva 50,0%, a približno trećina vakcinisanih bolesnika imala je blaži oblik COVID-19. Biološka terapija bila je uspešna bez obzira na privremeni prekid kod pojedinih bolesnika usled COVID-19 i pogoršanja psorijaze u tom periodu. Biološka terapija je bila uspešna bez obzira na privremeni prekid lečenja koji je nastao usled početka pandemije COVID-19 i pogoršanja psorijaze kod pojedinih bolesnika u tom periodu.
Reference
Korman NJ. Management of psoriasis as a systemic disease: what is the evidence? Br J Dermatol 2020; 182(4): 840–8.
Milčić D, Janković S, Vesić S, Milinković M, Janković J. As-sessment of quality of life in patients with psoriasis: a study from Serbia. Int J Dermatol 2015; 54(5): 523–8.
Gupta R, Debbaneh MG, Liao W. Genetic Epidemiology of Psoriasis. Curr Dermatol Rep 2014; 3(1): 61–78.
Di Meglio P, Villanova F, Nestle FO. Psoriasis. Cold Spring Harb Perspect Med 2014; 4(8): a015354.
Warren RB, Griffiths CE. Systemic therapies for psoriasis: methotrexate, retinoids, and cyclosporine. Clin Dermatol 2008; 26(5): 438–47.
Amin M, No DJ, Egeberg A, Wu JJ. Choosing first-line bio-logic treatment for moderate-to-severe psoriasis: what does the evidence say? Am J Clin Dermatol 2018; 19(1): 1–13.
Malinić D, Malinić M. The Impact of COVID-19 pandem-ic on strategic and operational risk. Financing 2020; 12(4): 3–19.
Fox A, Al-Wassiti H. 4 things about mRNA COVID vac-cines researcher still want to find out [Internet]. Gavi The Vaccine Alliance; 2021 [accessed on 2024 Aug 20]. Availa-ble from: https://www.gavi.org/vaccineswork/4-things-about-mrna-covid-vaccines-researchers-still-want-find-out?
gclid=CjwKCAiAxJSPBhAoEiwAeO
British Society for Immunology. Types of vaccines for COVID-19 [Internet]. London, EN: British Society for Immunology; 2021 [accessed on 2024 Aug 20]. Available from: https://www.immunology.org/coronavirus/connect-coron
avirus-public-engagement-resources/types-vaccines-for-co
vid-19
Dhama K, Khan S, Tiwari R, Sircar S, Bhat S, Malik YS, et al. Coronavirus Disease 2019-COVID-19. Clin Microbiol Rev 2020; 33(4): e00028–20.
Damiani G, Allocco F, Young Dermatologists Italian Network, Malagoli P. COVID‐19 vaccination and patients with pso-riasis under biologics: real‐life evidence on safety and ef-fectiveness from Italian vaccinated healthcare workers. Clin Exp Dermatol 2021; 46(6): 1106–8.
Gelfand JM, Armstrong AW, Bell S, Anesi GL, Blauvelt A, Calabrese C, et al. National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic dis-ease during the pandemic: Version 2-Advances in psoriat-ic disease management, COVID-19 vaccines, and COVID-19 treatments. J Am Acad Dermatol 2021; 84(5): 1254–68.
Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med 2020; 383(27): 2603–15.
Brazzelli V, Isoletta E, Barak O, Barruscotti S, Vassallo C, Giorgini C, et al. Does therapy with biological drugs influ-ence COVID-19 infection? Observational monocentric prevalence study on the clinical and epidemiological data of psoriatic patients treated with biological drugs or with topical drugs alone. Dermatol Ther 2020; 33(6): e14516.
Koons S. Vaccinating in the Time of COVID-19 [Inter-net]. USA: National Psoriasis Foundation; 2020 [accessed on 2024 Aug 20]. Available from: https://www.psoriasis.org/
advance/vaccinating-in-the-time-of-covid/
Wu PC, Huang IH, Wang CW, Tsai CC, Chung WH, Chen CB. New Onset and Exacerbations of Psoriasis Following COVID-19 Vaccines: A Systematic Review. Am J Clin Dermatol 2022; 23(6): 775–99.
Steen Martin D. How Severe is Your Psoriasis [Internet]. WebMD; 2021 [accessed on 2024 Aug 20]. Available from: https://www.webmd.com/skin-problems-and-treatments/
psoriasis/how-severe-your-psoriasis
Finlay AY. Current Severe Psoriasis and the Rule of Tens. Br J Dermatol 2005; 152(5): 861–7.
Mazzotti E, Barbaranelli C, Picardi A, Abeni D, Pasquini P. Psy-chometric properties of Dermatology Life Quality Index (DLQI) in 900 Italian patients with psoriasis. Acta Derm Ve-nereol 2005; 85(5): 409–13.
Mroz M, Mućka S, Miodońska M, Ziolkowska D, Hadas E, Bożek A. Influence of SARS-CoV-2 Virus Infection on the Course of Psoriasis during Treatment with Biological Drugs. Medicina (Kaunas) 2021; 57(9): 881.
Bragazzi NL, Riccò M, Pacifico A, Malagoli P, Kridin K, Pigatto P, et al. COVID-19 knowledge prevents biologics discontinua-tion: Data from an Italian multicenter survey during RED-ZONE declaration. Dermatol Ther 2020; 33(4): e13508.
Hägg D, Eriksson M, Sundström A, Schmitt-Egenolf M. The higher proportion of men with psoriasis treated with biologics may be explained by more severe disease in men. PLoS One 2013; 8(5): e63619.
Ormerod AD, Augustin M, Baker C, Chosidow O, Cohen AD, Dam TN, et al. Challenges for synthesising data in a network of registries for systemic psoriasis therapies. Dermatology 2012; 224(3): 236–43.
Rønholt K, Iversen L. Old and New Biological Therapies for Psoriasis. Int J Mol Sci 2017; 18(11): 2297.
Raudonis T, Gliebute A, Grigaityte AG, Lukosiunaite Z, Karmazi-ene T, Grigaitiene J. A Six-Year Analysis of Biological Therapy for Severe Psoriasis in a Lithuanian Reference Centre of Dermatovenereology. Medicina (Kaunas) 2020; 56(6): 275.
Chaptini C, Quinn S, Marshman G. Durable dermatology life quality index improvements in patients on biologics associated with psoriasis areas and severity index: a longitudinal study. Australas J Dermatol 2016; 57(3): e72–5.
Mattei PL, Corey KC, Kimball AB. Psoriasis Area Severity In-dex (PASI) and the Dermatology Life Quality Index (DLQI): the correlation between disease severity and psychological burden in patients treated with biological therapies. J Eur Acad Dermatol Venereol 2014; 28(3): 333–7.
Rashedi R, Samieefar N, Masoumi N, Mohseni S, Rezaei N. COVID-19 vaccines mix-and-match: The concept, the effica-cy and the doubts. J Med Virol 2022; 94(4): 1294–9.
Lodde GC, Krefting F, Placke JM, Schneider L, Fiedler M, Dittmer U, et al. COVID-19 vaccination in psoriasis patients receiving systemic treatment: A prospective single-center study. Front Immunol 2023; 14: 1107438.
Wang Q, Lv C, Han X, Shen M, Kuang Y. A Web-Based Survey on Factors for Unvaccination and Adverse Reactions of SARS-CoV-2 Vaccines in Chinese Patients with Psoriasis. J Inflamm Res 2021; 14: 6265–73.
Galluzzo M, D'Adamio S, Silvaggio D, Lombardo P, Bianchi L, Talamonti M. In which patients the best efficacy of secuki-numab? Update of a real-life analysis after 136 weeks of treatment with secukinumab in moderate-to-severe plaque psoriasis. Expert Opin Biol Ther 2020; 20(2): 173–82.
Gisondi P, Zaza G, Del Giglio M, Rossi M, Iacono V, Girolomoni G. Risk of hospitalization and death from COVID-19 infec-tion in patients with chronic plaque psoriasis receiving a bio-logic treatment and renal transplant recipients in maintenance immunosuppressive treatment. J Am Acad Dermatol 2020; 83(1): 285–7.
Amerio P, Prignano F, Giuliani F, Gualdi G. COVID-19 and psoriasis: Should we fear for patients treated with biolog-ics? Dermatol Ther 2020; 33(4): e13434.
Conforti C, Giuffrida R, Dianzani C, Di Meo N, Zalaudek I. Bio-logic therapy for psoriasis during the COVID-19 outbreak: The choice is to weigh risks and benefits. Dermatol Ther 2020; 33(4): e13490.