Could infection and systemic immunomodulation be the clue?

Danger and Defense in the Age of Biologics

Friday, March 25 | 7:30 – 8:30 a.m.

Room: 104A

Infectious disease and biologic immunomodulatory medicines, such as TNF-alpha and cytokine inhibitors are some of the most effective and important tools for treating dermatologic disease. Hepatitis B and C, HIV, herpes zoster, tuberculosis, and COVID-19 are just a few of the familiar infections that sometimes coexist with dermatologic disease.

Too often, however, fear of triggering new infection or exacerbating chronic infection has deprived dermatology patients of the best possible treatment using biologics and other systemic agents. Those fears and other considerations are among the topics that will be covered in the session U022 – Danger and Defense in the Age of Biologics.

“In nearly all clinical trials of new biologics, patients with HIV, hepatitis, TB, zoster, and other infectious disease were excluded, so there are no safety data in these patients,” said Kieron Leslie, MBBS, professor of dermatology at the University of California, San Francisco, and head of the HIV Dermatology Clinic at Zuckerberg San Francisco General Hospital. “These patients with significant skin disease often don’t get access to care because dermatologists are too frightened of the perceived risk of viral or bacterial disease to treat them appropriately.”

Most dermatologists check their patients for underlying infections prior to starting systemic therapy, whether conventional immunosuppressants or biologic therapies. However, a positive test will require new disease management and treatment considerations. Session panelists will speak to those concerns in cases such as Hepatitis B, Hepatitis C, HIV, and tuberculosis. The discussion will also include vaccination schedules prior to initiation of therapy as well as the management of immunosuppressants in the era of COVID-19.

Erin Huiras Amerson, MD, FAAD, chief of dermatology service at Zuckerberg San Francisco General Hospital and UCSF clinical professor of dermatology, will co-chair the session and will explore the latest findings in the use of biologics in dermatology patients with chronic viral or bacterial infection or are at risk for acute infection.

“Now we have two years of real-world [COVID-19] data and experience. For certain agents, it is important that patients are carefully monitored and, in the advent of testing positive or becoming symptomatic for COVID-19, they need rapid access to therapeutics. However, biologics should not be automatically withheld,” Dr. Amerson said.

Watch for more in-depth coverage of this session during AAD Annual Meeting in Boston. 

Visit AAD DermWorld Meeting News Central for more articles.