Characteristics associated with poor COVID-19 outcomes in people with psoriasis, psoriatic arthritis and axial spondyloarthritis: data from the COVID-19 PsoProtect and Global Rheumatology Alliance physician-reported registries

Abstract

ObjectivesTo investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).MethodsDemographic data, clinical characteristics and COVID-19 outcome severity of adults with PsO, PsA and axSpA were obtained from two international physician-reported registries. A three-point ordinal COVID-19 severity scale was defined: no hospitalisation, hospitalisation (and no death) and death. ORs were estimated using multivariable ordinal logistic regression.ResultsOf 5045 cases, 18.3% had PsO, 45.5% PsA and 36.3% axSpA. Most (83.6%) were not hospitalised, 14.6% were hospitalised and 1.8% died. Older age was non-linearly associated with COVID-19 severity. Male sex (OR 1.54, 95% CI 1.30 to 1.83), cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25–2.89), moderate/high disease activity and/or glucocorticoid use (ORs 1.39–2.23, vs remission/low disease activity and no glucocorticoids) were associated with increased odds of severe COVID-19. Later pandemic time periods (ORs 0.42–0.52, vs until 15 June 2020), PsO (OR 0.49, 95% CI 0.37 to 0.65, vs PsA) and baseline exposure to TNFi, IL17i and IL-23i/IL-12+23i (OR 0.57, 95% CI 0.44 to 0.73; OR 0.62, 95% CI 0.45 to 0.87; OR 0.67, 95% CI 0.45 to 0.98; respectively; vs no disease-modifying antirheumatic drug) were associated with reduced odds of severe COVID-19.ConclusionOlder age, male sex, comorbidity burden, higher disease activity and glucocorticoid intake were associated with more severe COVID-19. Later pandemic time periods, PsO and exposure to TNFi, IL17i and IL-23i/IL-12+23i were associated with less severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics.

Impact of COVID-19 on Medical Care Conduct and Psychological Burden Among Patients With Psoriasis: Real-World Data From a Tertiary Hospital in China

“…Interestingly, patients on biologic therapy were less likely to be hospitalized 13 and were associated with decreased odds of incident COVID-19 14 and less severe COVID-19. 15 Therefore, patients who are not infected with SARS-CoV-2 are recommended to continue their biologic or oral therapies for psoriasis and/ or psoriatic arthritis in most cases. 8 The patients with psoriasis did not have adequate knowledge of the effect of both psoriasis itself and its treatment on COVID-19.…”

Risk of severe coronavirus disease 2019 despite vaccination in patients requiring treatment with immune‐suppressive drugs: A nationwide cohort study of US Veterans

“…This risk was identified early in the COVID-19 pandemic and persisted after distribution and administration of effective vaccines. [1][2][3][4][5][6][7][8][9] The Centers for Disease Control and Prevention recommends consideration of antiviral treatment for such patients after diagnosis of infection regardless of vaccination status. 10,11 Many studies of vaccinated immunocompromised patients focused on serologic responses, 5,12 with clinical outcomes of subsequent infection reported less frequently, mostly in series from registries.…”

“…10,11 Many studies of vaccinated immunocompromised patients focused on serologic responses, 5,12 with clinical outcomes of subsequent infection reported less frequently, mostly in series from registries. 1,4,6 We reported risk factors associated with severe (compared to non-severe) SARS-CoV-2 infection despite vaccination in a cohort of over 110,000 US Veterans. 13 Although increasing age had the strongest association with severe "breakthrough" infection in multivariable logistic regression, use of immune-suppressive drugs was also strongly associated, with 5 broad classes of drugs having clinically-and statisticallysignificant adjusted odds ratios (aORs): glucocorticoids 2.34 (confidence interval [CI] 2.18-2.50), cytokine-blocking 1.66 (1.32-2.09), leukocyte-inhibitory 2.80 (2.39-3.28), B-cell-depleting 2.07 (1.57-2.72), and cytotoxic chemotherapy 2.71 (2.27-3.24).…”

“…A separate study in the UK reported a stronger association of severe COVID-19 with immune-suppressive drugs, with an adjusted risk ratio (aRR) of 5.80, with particularly high risk after transplantation (aRR 6.61-23.35), higher than any other comorbidities. 14 Case series from large registries, mostly but not exclusively including unvaccinated patients, have shown variable risk associated with anti-metabolite drugs (methotrexate, mercaptopurines, mycophenolate) but typically higher risk with glucocorticoids, 9,15 Janus kinase (JAK) inhibitors, 3,6 and rituximab, 3,4,15 and lower risk with other biologics, with anti-tumor necrosis factor (anti-TNF) receiving study across multiple inflammatory diseases. 2,[6][7][8] The primary aim of the current study was to measure associations with severe SARS-CoV-2 infection despite vaccination in patients with solid organ transplantation (SOT) or one of three relatively common inflammatory diseases in which multiple different treatments are used: rheumatoid arthritis (RA), inflammatory bowel diseases (IBDs), and psoriasis.…”

“…The risk for severe illness from severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection is increased by the use of immune‐suppressive drugs. This risk was identified early in the COVID‐19 pandemic and persisted after distribution and administration of effective vaccines 1–9 . The Centers for Disease Control and Prevention recommends consideration of antiviral treatment for such patients after diagnosis of infection regardless of vaccination status 10,11…”