How COVID-19 affects patients receiving anticytokine and JAK inhibitors in rheumatology and dermatology

d-Dimer trend in a long-term rheumatoid arthritis patient with tofacitinib treatment and recent COVID-19 infection

The SARS-CoV-2 virus was first identified in December 2019, the infection was named COVID-19. The initial symptoms and evolution of the disease have been described over the past year. The virus has been shown to increase the risk of thromboembolic events due to the hypercoagulable state triggered by systemic endothelial inflammation. We present the case of a patient with a history of rheumatoid arthritis under prolonged treatment with tofacitinib, who presented COVID-19 and subsequently developed a hypercoagulable state of approximately 6 months’ duration. The possible association between viral infection and the use of tofacitinib is debated.

Januskinase-Inhibitoren: Next-Generation-Therapie der Uveitis

Viele PatientInnen mit visusgefährdender nicht infektiöser Uveitis bedürfen, um eine Remission ihrer Uveitis zu erreichen, einer Behandlung mit DMARDs. Obwohl herkömmliche DMARD-Therapien in einem großen Teil dieser PatientInnen eine hochpotente Therapie darstellen, ist in einzelnen Fällen aufgrund eines unzureichenden Ansprechens oder unerwünschter Wirkungen ein Therapiewechsel erforderlich. Januskinase-Inhibitoren (JAKI) sind in der Rheumatologie, Gastroenterologie und Dermatologie bereits für mehrere autoimmune Erkrankungen zugelassen. Nun steht ein Zulassungsprozess für ausgewählte Uveitisentitäten an. Wirkmechanismus: JAKI üben ihre Wirkung über die Hemmung der Phosphorylierung von Transmembranproteinen, den Januskinasen aus. Dies führt zu einer fehlenden Aktivierung von Transkriptionsfaktoren und damit zur verminderten Zytokinexpression und Entzündungshemmung. JAKI stellen in der Rheumatologie, Gastroenterologie und Dermatologie einen äußerst effektiven neuen therapeutischen Ansatz dar. Sie sind zur Behandlung bei rheumatoider Arthritis, Psoriasis-Arthritis, ankylosierender Spondylitis, Colitis ulcerosa und dem atopischen Ekzem bereits zugelassen. In bisherigen Vergleichsstudien zu etablierten Biologika konnte teilweise ein besseres therapeutisches Ansprechen beschrieben werden. Aus publizierten Fallberichten wurde auch bei Uveitispatienten, die auf klassische und biologische DMARDs unzureichend ansprachen, eine Kortisoneinsparung und Reizfreiheit erzielt. Zulassungsstudien bei JIA-assoziierter und ANA-positiver anteriorer Uveitis sind im Prozess. Zusammenfassend stellen JAKI eine innovative Therapieoption bei Patienten mit nicht infektiöser Uveitis dar, bei denen Kontraindikationen gegen die Verwendung oder ein unzureichender Effekt von DMARDs bestehen.

Sex-tailored pharmacology and COVID-19: Next steps towards appropriateness and health equity

Making gender bias visible allows to fill the gaps in knowledge and understand health records and risks of women and men. The coronavirus disease 2019 (COVID-19) pandemic has shown a clear gender difference in health outcomes. The more severe symptoms and higher mortality in men as compared to women are likely due to sex and age differences in immune responses. Age-associated decline in sex steroid hormone levels may mediate proinflammatory reactions in older adults, thereby increasing their risk of adverse outcomes, whereas sex hormones and/or sex hormone receptor modulators may attenuate the inflammatory response and provide benefit to COVID-19 patients. While multiple pharmacological options including anticoagulants, glucocorticoids, antivirals, anti-inflammatory agents and traditional Chinese medicine preparations have been tested to treat COVID-19 patients with varied levels of evidence in terms of efficacy and safety, information on sex-targeted treatment strategies is currently limited. Women may have more benefit from COVID-19 vaccines than men, despite the occurrence of more frequent adverse effects, and long-term safety data with newly developed vectors are eagerly awaited. The prevalent inclusion of men in randomized clinical trials (RCTs) with subsequent extrapolation of results to women needs to be addressed, as reinforcing sex-neutral claims into COVID-19 research may insidiously lead to increased inequities in health care. The huge worldwide effort with over 3000 ongoing RCTs of pharmacological agents should focus on improving knowledge on sex, gender and age as pillars of individual variation in drug responses and enforce appropriateness.

An evidence-based guide to SARS-CoV-2 vaccination of patients on immunotherapies in dermatology

Immune-mediated diseases and immunotherapeutics can negatively affect normal immune functioning and, consequently, vaccine safety and response. The COVID-19 pandemic has incited research aimed at developing a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine. As SARS-CoV-2 vaccines are developed and made available, the assessment of anticipated safety and efficacy in patients with immune-mediated dermatologic diseases and requiring immunosuppressive and/or immunomodulatory therapy is particularly important. A review of the literature was conducted by a multidisciplinary committee to provide guidance on the safety and efficacy of SARS-CoV-2 vaccination for dermatologists and other clinicians when prescribing immunotherapeutics. The vaccine platforms being used to develop SARS-CoV-2 vaccines are expected to be safe and potentially effective for dermatology patients on immunotherapeutics. Current guidelines for the vaccination of an immunocompromised host remain appropriate when considering future administration of SARS-CoV-2 vaccines.