Adherence to biological therapy in dermatological patients during the COVID‐19 pandemic in Western Sicily

Le résumé fourni par la source

Dear Editor, COVID-19 has changed all aspects of health care globally, including the way hospital personnel approaches chronic patients. As dermatologists, this has especially reflected in how we have been dealing with psoriasis, atopic dermatitis, and hidradenitis suppurativa since March 2020. Even though patients are often concerned about the immunosuppressive nature of biological therapies, discontinuation of treatment in patients affected by chronic diseases is neither desirable nor recommended. Thus, our major everyday challenge is to ensure continuity of treatment while meeting the regulations concerning the risk reduction of COVID-19 spread between patients and clinicians. Since the start of the pandemic until September 2020, our Italian region of Sicily has reported about 4849 cases of COVID-19, fewer than 300 deaths,1 and a lethality rate of about 9%. During the lockdown phase, our group has observed 456 patients in therapy with various biological drugs for psoriasis, atopic dermatitis, and hidradenitis suppurativa. Treatments for psoriasis included adalimumab, etanercept, brodalumab, guselkumab, ixekizumab, secukinumab, and ustekinumab. Patients with atopic dermatitis were treated with dupilumab and those affected by hidradenitis suppurativa with adalimumab. On the basis of national and international indications,2-4 our patients did not discontinue treatment. They were reassured and contacted periodically by our clinicians to check on their health. None of those patients contracted SARS-CoV-2 infection, and none reported close social contacts with positive subjects. Among the 456 patients, only two stopped treatment, while 25 extended the dosing interval (Table 1). The median duration of the lengthening was 28 days (range 14–37 days). The two patients who discontinued therapy were receiving dupilumab. They referred that their choice was dictated by fear of contagion, although they were informed that dupilumab does not alter the immune compartments involved in host defense against viruses. Curiously, these two patients were fairly young, both 33 years, hence with a lower death risk for COVID-19. Comparing our results with those of other recently published studies, our rate of discontinued therapies is much lower.5, 6 Undoubtedly, in the total result, the smallest sample certainly had an influence. It is also worth mentioning that patients who chose to stretch the dosing interval of their treatment only did so in the early lockdown period, probably because of the initial lack of correct information. There were no substantial differences in the decisions of patients receiving anti-TNF-alpha and those receiving anti-interleukin therapy. Of note, the two patients who discontinued therapy had no exacerbation of the disease and resumed therapy regularly after 2 months. During the lockdown period, numerous preventive precautions were put into immediate practice in Italy. The adoption of a distance education system, social distancing, gathering and public transport restrictions, and the "stay at home" campaign encouraged everyone to move less. This inevitably led to a drastic reduction in hospital admissions, limiting them to emergencies. The success of our use of teledermatology for therapeutic continuity was achieved in strict coordination with our hospital pharmacy. This cooperation guaranteed patient's drug accessibility without the need to traverse the most crowded hospital areas. Ultimately, this led to high therapeutic adherence (>99%). A continuous dialogue with patients, who in this period of uncertainty needed more information and reassurance, was also pivotal. In this sense, the support of technology has proven invaluable, allowing us to interact with patients who were safely and comfortably staying at home. The SARS-CoV-2 pandemic has undoubtedly altered the organization of public hospitals, but like all highly stressful events, it has also improved the resiliency of our system, improving resource management and optimization.

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