Background The multi-morbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse COVID-19 outcomes but data are limited. Objective Characterize the course of COVID-19 in psoriasis and identify factors associated with hospitalization. Methods Clinicians reported psoriasis patients with confirmed/suspected COVID-19 via an international registry, PsoProtect. Multiple logistic regression assessed the association between clinical/demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviours. Results Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% a non-biologic and 10% no systemic treatment for psoriasis. 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted OR 1.59 per 10 years, 95% CI 1.19-2.13), male sex (OR 2.51, 95% CI 1.23-5.12), non-white ethnicity (OR 3.15, 95% CI 1.24-8.03) and comorbid chronic lung disease (OR 3.87, 95% CI 1.52-9.83). Hospitalization was more frequent in patients using non-biologic systemic therapy than biologics (OR 2.84, 95% CI 1.31-6.18). No significant differences were found between biologic classes. Independent patient-reported data (n=1,626 across 48 countries) suggested lower levels of social isolation in individuals receiving non-biologic systemic therapy compared to biologics (OR 0.68, 95% CI 0.50-0.94). Conclusion In this international moderate-severe psoriasis case series, biologics use was associated with lower risk of COVID-19-related hospitalization than non-biologic systemic therapies, however further investigation is warranted due to potential selection bias and unmeasured confounding. Established risk factors (being older, male, non-white ethnicity, comorbidities) were associated with higher hospitalization rates. Clinical Implications We identify risk factors for COVID-19-related hospitalization in psoriasis patients, including older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic therapies.

This study highlights phenotypic features of psoriasis in elderly and in very late onset psoriasis. The management of these fragile patients remains poorly codified and needs further investigation.

IMPORTANCE Psoriasis is a chronic inflammatory disease. The Mediterranean diet has been shown to reduce chronic inflammation and has a positive effect on the risk of metabolic syndrome and cardiovascular events. Thus, we hypothesized a positive effect on the onset and/or severity of psoriasis. OBJECTIVE To assess the association between a score that reflects the adhesion to a Mediterranean diet (MEDI-LITE) and the onset and/or severity of psoriasis. DESIGN, SETTING, AND PARTICIPANTS The NutriNet-Santé program is an ongoing, observational, web-based questionnaire cohort study launched in France in May 2009. The present study was performed within the framework of the NutriNet-Santé program, with data collected and analyzed between April 2017 and June 2017. Patients with psoriasis were identified via a validated online self-completed questionnaire and then categorized by disease severity: severe psoriasis, nonsevere psoriasis, and psoriasis-free. Data on dietary intake (including alcohol) were gathered during the first 2 years of participation in the cohort to calculate the MEDI-LITE score (ranging from 0 for no adherence to 18 for maximum adherence). Potentially confounding variables (eg, age, sex, physical activity, body mass index, tobacco use, and a history of cardiovascular disease) were also recorded. Analyses used adjusted multinomial logistic regression to estimate the risk of having severe psoriasis or nonsevere psoriasis compared with being psoriasis-free. RESULTS Of the 158 361 total NutriNet-Santé participants, 35 735 (23%) replied to the psoriasis questionnaire. The mean (SD) age of the respondents was 47.5 (14.0) years; 27 220 (76%) of the respondents were women. Of these 35 735 respondents, 3557 (10%) individuals reported having psoriasis. The condition was severe in 878 cases (24.7%), and 299 (8.4%) incident cases were recorded (those arising more than 2 years after participant inclusion in the cohort). After adjustment for confounding factors, a significant inverse relationship was found between the MEDI-LITE score and having severe psoriasis: odds ratio (OR), 0.71; 95% CI, 0.55-0.92 for the MEDI-LITE score's second tertile (score of 8 to 9); and OR, 0.78; 95% CI, 0.59-1.01 for the third tertile (score of 10 to 18). CONCLUSIONS AND RELEVANCE Patients with severe psoriasis displayed low levels of adherence to the Mediterranean diet; this finding supports the hypothesis that the Mediterranean diet may slow the progression of psoriasis. If these findings are confirmed, adherence to a Mediterranean diet should be integrated into the routine management of moderate to severe psoriasis.

JEADV AbstractBackground Three biotherapiesetanercept, adalimumab and ustekinumabare licensed in childhood psoriasis. The few data available on their efficacy and tolerance are mainly derived from industry trials. However, biological drug survival impacts long-term performance in real-life settings.Objective The objective of this study was to evaluate the survival rates of biological therapies in children with psoriasis in real-life conditions. Secondary objectives were to evaluate the factors associated with the choice of the biological therapy and to report severe adverse events. Materials and methodsThis study was an observational retrospective study. Data were extracted from the clinical records of 134 children. Kaplan-Meier estimates were used to analyse drug survival overall and in subgroups of plaque psoriasis, bio-na€ ıve and non-na€ ıve patients. ResultsWe analysed 184 treatment courses: 70 with etanercept, 68 with adalimumab and 46 with ustekinumab.Factors associated with the choice of first-line biological agent were age at initiation (younger for adalimumab, P < 0.0001), age at onset of psoriasis (younger for adalimumab and etanercept, P = 0.03) and baseline Psoriasis Assessment Severity Index and Physician global assessment (both higher for adalimumab, P < 0.001). Drug survival rates were higher for ustekinumab than for adalimumab and etanercept (P < 0.0001) for all treatment and all psoriasis types, plaque-type psoriasis (P = 0.0003), patients na€ ıve for biological agents (P = 0.0007) and non-na€ ıve patients (P = 0.007). We reported eight serious adverse events (SAEs): severe infections (n = 3), significant weight gain (n = 2), psoriasis flare (n = 1) and malaise (n = 1). Biological therapy was discontinued in three children (one with psoriasis flare and two with weight gain). Only the two cases of weight gain resulted in an unfavourable outcome.Conclusions Our real-life comparative study found that ustekinumab had the best drug survival outcome. The profile of SAEs in children was comparable to that in adults. These results will assist dermatologists in the decision-making process when choosing treatment options for children with psoriasis in daily practice.

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Anti-interleukin-17 agents have recently been developed for the treatment of psoriasis. This study evaluated the tolerance and effectiveness of anti-interleukin-17 agents for psoriasis in elderly patients in daily practice. A multicentre, retrospective study was performed, involving psoriatic patients aged ≥65 years who had received an anti-interleukin-17 agent, including secukinumab, ixekizumab or brodalumab. A total of 114 patients were included: 72 received secukinumab, 35 ixekizumab, and 7 brodalumab. Treatment was stopped in 32 patients (28.9%), because of relapses in 14 patients (41.2%), primary failures in 11 patients (32.4%), or adverse events in 7 patients (20.6%). The 3 most frequently reported adverse events were injection site reactions ( n = 4), oral candidiasis ( n = 3), and influenza-like illness ( n = 3). Regarding effectiveness, 80 patients (70%) reached a Physician Global Assessment score of 0/1, 6 months after treatment initiation. In conclusion, anti-interleukin-17 therapy appears to be an effective and safe therapeutic option for psoriasis treatment in patients aged ≥ 65 years.

Ethics Declarations: In France and Itlay, ethic declaration is not necessary for retrospective date. We only required the "non-opposition for participating to the study" Funding: No sources of funding were used to conduct this study or prepare this manuscript.

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