Management of patients with psoriasis treated with biological drugs needing a surgical treatment.
Tumor necrosis factor alpha (TNF-α) is a cytokine that plays a critical role in inflammatory and immune processes and in the control of infections and sepsis. Data on the perioperative management of patients treated with biologic drugs are limited and mainly in patients with rheumatoid arthritis (RA) and inflammatory bowel disease (IBD). This retrospective study assesses variations in the incidence of side effects between psoriatic patients who temporarily discontinue or continue biological therapy before surgical treatment. Despite the immunosuppressive risk, our results suggest that postoperative complications are not influenced by the suspension of biologic therapies. As TNF-α plays a role in promoting collagen synthesis and wound healing, we suggest that anti-TNFs should be discontinued before major surgery, whereas for minor surgery, the lower rates of infections favor anti-TNF-α continuation, particularly since suspending anti-TNF therapy is known to induce psoriasis relapse.
Dermatologic Unit, Department of Head and Neck Surgery, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Italy.
Antonella
A
Fabiano
Clara
C
De Simone
Paolo
P
Gisondi
Stefano
S
Piaserico
Claudia
C
Lasagni
Giovanni
G
Pellacani
Andrea
A
Conti
D000068879:Adalimumab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use*; D000068800:Etanercept; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D015994:Incidence; D000069285:Infliximab; D018664:Interleukin-12 / Q000037:antagonists & inhibitors; D053759:Interleukin-23 / Q000037:antagonists & inhibitors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology*; D011565:Psoriasis / Q000188:drug therapy* / Q000601:surgery*; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D013514:Surgical Procedures, Operative; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D000069549:Ustekinumab; D014945:Wound Healing
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D001688:Biological Products; D007074:Immunoglobulin G; D053759:Interleukin-23; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D018664:Interleukin-12; D000069285:Infliximab; D000069549:Ustekinumab; D000068879:Adalimumab; D000068800:Etanercept
anti IL 12/23; anti TNF-α; infections; psoriasis; surgical complications