Background: This study is a revision and a review of three papers published in our Dermatology department in Fondazione I.R.C.C.S Policlinico San Matteo, in Pavia, from January 2020 through to July 2022. Following the themes of each paper, this thesis covers three main arguments regarding the topic of psoriatic patients on biologic therapy during the pandemic. The first is the course and severity of infection in psoriatic patients on biologics, the second is the seroprevalence of SARS-CoV-2 in these patients, and the third and final argument covers the safety and efficacy of the BNT162b2 vaccine in these patients. This thesis will review any other available articles regarding this topic to discuss and assess the life and treatment of psoriatic patients on biologics during the pandemic, and the relevance of frailty in the patients. Materials and methods: The keywords “Psoriasis”, “Biologics”, “SARS-CoV-2”, “COVID-19” and “BNT162b2” were used in various combinations on different database engines (Pubmed, Google Scholar, Scopus, and Cochrane Library) to find relevant articles on this topic. Results: A total of 52 articles were found, 24 concerning the course and severity of SARS-CoV-2 in psoriatic patients on biologic therapy, 5 regarding seroprevalence of SARS-CoV-2, and 25 concerning safety and efficacy of BNT162b2 in these patients. Conclusion: Psoriatic patients on biologic therapy were not at an increased risk of SARS-CoV-2 infection and did not experience the infection worse than the general population. The immunosuppressive action of biologics may even protect the patient as patients on biologic therapy had better outcomes and less risk of severe infection than the general population. Seroprevalence of SARS-CoV-2 in psoriatic patients on biologics was similar to that of the general population, indicating that they are not at increased risk of infection. The seroconversion rate against SARS-CoV-2 from the BNT162b2 vaccine was similar in both psoriatic patients on biologics and the general public, indicating efficacy is not hindered. However, the cellular response was significantly worse and the humoral immune response was weaker than in the general population, indicating the possibility of tighter vaccination schedules and additional doses may be advantageous in these patients.
Scopo: Questo studio è una revisione e una recensione di tre articoli pubblicati nel nostro Dipartimento di Dermatologia presso la Fondazione I.R.C.C.S Policlinico San Matteo, a Pavia, da gennaio 2020 a luglio 2022. Seguendo i temi di ogni articolo, questa tesi copre tre argomenti principali riguardanti il tema dei pazienti psoriasici in terapia biologica durante la pandemia. Il primo è il decorso e la gravità dell’infezione nei pazienti psoriasici in terapia biologica, il secondo è la sieroprevalenza di SARS-CoV-2 in questi pazienti e il terzo e ultimo argomento riguarda la sicurezza e l’efficacia del vaccino BNT162b2 in questi pazienti. Questa tesi esaminerà eventuali altri articoli disponibili riguardo a questo argomento per discutere e valutare la vita e il trattamento dei pazienti psoriasici in terapia biologica durante la pandemia e la rilevanza della fragilità nei pazienti. Materiali e metodi: Le parole chiave “Psoriasi”, “Biologici”, “SARS-CoV-2”, “COVID-19” e “BNT162b2” sono state utilizzate in varie combinazioni su diversi motori di ricerca (Pubmed, Google Scholar, Scopus e Cochrane Library) per trovare articoli rilevanti su questo argomento. Risultati: Sono stati trovati un totale di 52 articoli, 24 riguardanti il decorso e la gravità di SARS-CoV-2 nei pazienti psoriasici in terapia biologica, 5 riguardanti la sieroprevalenza di SARS-CoV-2 e 25 riguardanti la sicurezza e l’efficacia di BNT162b2 in questi pazienti. Conclusione: I pazienti psoriasici in terapia biologica non erano a un rischio aumentato di infezione da SARS-CoV-2 e non hanno sperimentato l’infezione peggio della popolazione generale. L’azione immunosoppressiva dei biologici può addirittura proteggere il paziente poiché i pazienti in terapia biologica avevano risultati migliori e meno rischio di infezione grave rispetto alla popolazione generale. La sieroprevalenza di SARS-CoV-2 nei pazienti psoriasici in terapia biologica era simile a quella della popolazione generale, indicando che non sono a rischio aumentato di infezione. Il tasso di sieroconversione contro SARS-CoV-2 dal vaccino BNT162b2 era simile sia nei pazienti psoriasici in terapia biologica che nel pubblico generale, indicando che l’efficacia non è ostacolata. Tuttavia, la risposta cellulare era significativamente peggiore e la risposta immunitaria umorale era più debole rispetto alla popolazione generale, indicando che la possibilità di programmi vaccinali più stretti e dosi aggiuntive potrebbe essere vantaggiosa in questi pazienti.
PSORIASIS AND BIOLOGICAL DRUGS AT THE TIME OF SARS-COV-2 INFECTION IN PSORIATIC PATIENTS: FROM THE STUDY OF THE PREVALENCE AND COURSE OF THE INFECTION, TO THE STUDY OF SEROPREVALENCE, AND FINALLY TO THE DYNAMICS OF IMMUNITY HUMORAL AND CELLULAR ELICITED BY BNT162B2 MRNA VACCINE.
RAILTON, JANOSCH
2022/2023
Abstract
Background: This study is a revision and a review of three papers published in our Dermatology department in Fondazione I.R.C.C.S Policlinico San Matteo, in Pavia, from January 2020 through to July 2022. Following the themes of each paper, this thesis covers three main arguments regarding the topic of psoriatic patients on biologic therapy during the pandemic. The first is the course and severity of infection in psoriatic patients on biologics, the second is the seroprevalence of SARS-CoV-2 in these patients, and the third and final argument covers the safety and efficacy of the BNT162b2 vaccine in these patients. This thesis will review any other available articles regarding this topic to discuss and assess the life and treatment of psoriatic patients on biologics during the pandemic, and the relevance of frailty in the patients. Materials and methods: The keywords “Psoriasis”, “Biologics”, “SARS-CoV-2”, “COVID-19” and “BNT162b2” were used in various combinations on different database engines (Pubmed, Google Scholar, Scopus, and Cochrane Library) to find relevant articles on this topic. Results: A total of 52 articles were found, 24 concerning the course and severity of SARS-CoV-2 in psoriatic patients on biologic therapy, 5 regarding seroprevalence of SARS-CoV-2, and 25 concerning safety and efficacy of BNT162b2 in these patients. Conclusion: Psoriatic patients on biologic therapy were not at an increased risk of SARS-CoV-2 infection and did not experience the infection worse than the general population. The immunosuppressive action of biologics may even protect the patient as patients on biologic therapy had better outcomes and less risk of severe infection than the general population. Seroprevalence of SARS-CoV-2 in psoriatic patients on biologics was similar to that of the general population, indicating that they are not at increased risk of infection. The seroconversion rate against SARS-CoV-2 from the BNT162b2 vaccine was similar in both psoriatic patients on biologics and the general public, indicating efficacy is not hindered. However, the cellular response was significantly worse and the humoral immune response was weaker than in the general population, indicating the possibility of tighter vaccination schedules and additional doses may be advantageous in these patients.È consentito all'utente scaricare e condividere i documenti disponibili a testo pieno in UNITESI UNIPV nel rispetto della licenza Creative Commons del tipo CC BY NC ND.
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https://hdl.handle.net/20.500.14239/15960