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COVID-19: risk for cytokine targeting in chronic inflammatory diseases?

https://www.nature.com/articles/s41577-020-0312-7

Commentary: Andrew Blauvelt, MD

In this excellent paper in Nature Reviews Immunology, a rheumatologist, a dermatologist, and a gastroenterologist from Erlangen, Germany discuss biologic treatment of patients with chronic inflammatory diseases, including psoriasis, psoriatic arthritis, and atopic dermatitis. They effectively argue and conclude that most classes of biologics (including TNF, IL-12/23, IL-17A, IL-23, and IL-4/IL-13 blockers) utilized to treat chronic inflammatory diseases are likely to be safe in the context of the current COVID-19 pandemic. A word of caution is advised, however, on one type of drug class, JAK inhibitors, which may make patients more susceptible to viral infections in general. The bottom line is that the authors deliver a powerful science-based message that is extremely relevant to our patients, and we should take it to heart.

Despite many years of both clinical study-derived and real-world safety data in our patients using biologic therapy to treat these diseases, there still exist widespread misconception that biologics, in general, are unsafe. The key problem is that biologics are far too often lumped together in terms of safety. How often have we heard, “biologics do this,” “biologics do that,” and “biologics are associated with this and that.” Unfortunately, these statements and the views associated with them are antiquated. The term “biologic” is simply used to describe a drug that is created in a biologic manner, i.e., in cell culture, as opposed to being made through chemistry, as are most pharmaceuticals. The term “biologic” does not confer any insight as to the mechanism of action and/or the associated safety profile of a given drug. Understanding mechanism of action of any drug class, whether it’s a TNF, IL-12/23, IL-17A, IL-23, or IL-4/IL-13 blocker, helps inform us as to the distinct and unique safety profiles associated with each of these types of biologic.