A group of 18 physician voting members, commissioned by the National Psoriasis Foundation (NPF), developed a scientifically based guidance to promote the optimal management of psoriatic disease during the COVID-19 pandemic. A paper regarding the task force's consensus and process was published online in the Journal of the American Academy of Dermatology.
The task force included expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care from different geographical areas within the United States and Canada. In addition to the voting members, the task force was supported by several nonvoting members, including four trainees in dermatology, rheumatology, and infectious disease, one postdoctoral fellow in epidemiology, and senior staff from the NPF. The task force was led by Joel M. Gelfand, MD, MSCE, and Christopher T. Ritchlin, MD, MPH.
To develop the guidance, Drs Gelfand and Ritchlin completed weekly literature searches for articles on COVID-19 in relation to psoriatic disease. Additional task force members recommended other articles with broad importance to COVID-19, and resources from the Centers for Disease Control and Prevention, World Health Organization, FDA, and National Institutes of Health were consulted. The task force met every 2 weeks to discuss this literature and their own clinical experience.
The NPF provided clinical questions as received by their patient and clinical communities, and these questions were divided into five categories:
- What are the effects of psoriatic disease itself on SARS-CoV-2 infection and COVID-19 illness?
- What are the effects of psoriasis or psoriatic arthritis treatment on SARS-CoV-2 infection and COVID-19 illness?
- How should medical care be delivered to patients with psoriatic disease to lower their risk of infection with SARS-CoV-2 while still ensuring quality of care?
- What should patients with psoriatic disease do to protect themselves from becoming infected with SARS-CoV-2?
- What should patients with psoriatic disease do if they become infected with SARS-CoV-2?
Working groups with balanced expertise were created, and each group drafted responses to the clinical questions based on the available evidence. From these responses, guidance statements were drafted.
Watch Dr Gelfand discuss the COVID-19 pandemic and how to approach psoriatic disease management with biologics in this exclusive 8-minute video interview from our Coping During COVID series!
The collective of statements were presented to the task force using a modified Delphi process based on the RAND appropriateness method, which included two rounds of voting and discussion. Each member was asked to anonymously report their level of agreement with each guidance statement on a scale of 1 to 9 (1 = complete disagreement, 5 = neutral/uncertain, 9 = complete agreement), and they could provide additional written comments. Consensus was interpreted as high if all votes fell within a single median range (ie, level of agreement 7-9), and other combinations of votes were considered moderate level of consensus.
In total, 22 guidance statements had 100% complete voting. All 22 statements were recommended, with 9 having high consensus and 13 having moderate consensus. The guidance statements can be accessed on the NPF website.
The task force noted that their guidance statements are a living document that should be updated and amended as necessary during the COVID-19 pandemic.
Gelfand JM, Armstrong AW, Bell S, et al. National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: version 1. J Am Acad Dermatol. Published online September 3, 2020. doi:10.1016/j.jaad.2020.09.001