The Impact of IMID Treatment on COVID-19 Risk

Joel M. Gelfand, MD, MSCE, kicked off the session “Immunologic Lessons From COVID-19 for IMID Care” at the Interdisciplinary Autoimmune Summit (IAS) with a discussion on COVID toes by saying, “In spring 2020, COVID toes were reported to occur 1 to 4 weeks post onset of COVID-19 symptoms.” He explained, “COVID toes are red-purple or purpuric macules on fingers, elbows, toes, and the lateral aspect of the feet.” He further added, “Looking a lot like pernio-like acral lesions, it does usually resolve within 2 to 8 weeks, but it has been reported in long-haulers as well.”

Because evidence that SARS-COV-2 causes COVID toes is lacking, Dr Gelfand discussed important lessons for treatment of patients with COVID toes. He emphasized the need for rigorous epidemiologic studies and suggested that “COVID toes may not be a real entity and if real, clinical significance is unclear.” Dr Gelfand produced some recent data on psoriasis treatment and COVID-19, concluding that “psoriasis flares from COVID vaccines may be coincidental and are not a reason to not get vaccinated.”

Additionally, Dr Gelfand stated that it is often difficult to predict outcomes based on mechanisms of action. He answered the vital question of whether the COVID-19 vaccine can flare psoriasis and explained that “information to date does not suggest that psoriasis exacerbations have been reported disproportionately after COVID-19 vaccines compared to other types of vaccines.” He added, “If COVID vaccines cause psoriasis flares, incidence is likely very rare.”

For COVID-19 vaccines, Dr Gelfand recommended that psoriasis patients continue their biologic or oral therapies for psoriasis and/or psoriatic arthritis in most cases and get a booster shot “5 months post-mRNA vaccine (12 and older if Pfizer, 18+ Moderna) and 2 months post J&J (get an mRNA booster).” He further asked to “consider holding methotrexate x 2 weeks post booster.” For isolation in psoriasis patients with COVID-19, Dr Gelfand recommended following general COVID-19 guidelines with some extra precautions, such as using a 3-ply surgical mask, utilizing antigen or PCR based testing at day 5 of isolation, and extending the isolation period to at least 10 and up to 20 days.

To conclude, Dr Gelfand recommended 4 outpatient management treatments for COVID-19:

• Nirmatrelvir 300 mg plus ritonavir 100 mg orally twice daily for 5 days
• Sotrovimab 500 mg, administered as a single intravenous (IV) infusion
• Remdesivir 200 mg IV on day 1, followed by remdesivir 100 mg IV on days 2 and 3
• Molnupiravir 800 mg orally twice daily for 5 days

Reference
Gelfand JM, Hanauer SB, Calabrese L. Immunologic lessons from COVID-19 for IMID care. Presented at: Interdisciplinary Autoimmune Summit; April 9–11, 2022; Virtual.