Coronavirus Disease 2019 (COVID-19)-Associated Hospitalization and Mortality in Patients with Psoriasis: A Population-Based Study

Abstract

Background The impact of immune-related conditions on the outcomes of coronavirus disease 2019 (COVID-19) is poorly understood. Determinants of COVID-19 outcomes among patients with psoriasis are yet to be established. Objective Th objective of this study was to characterize a large cohort of patients with psoriasis with COVID-19 and to identify predictors of COVID-19-associated hospitalization and mortality. Methods A population-based nested case-control study was performed using the computerized database of Clalit Health Services, Israel. Multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence (CIs) of predictors for COVID-19-associated hospitalization and mortality. Results The study population included 3151 patients with psoriasis who tested positive for COVID-19. Subclinical COVID-19 infection occurred in 2818 (89.4%) of the patients while 122 (3.9%), 71 (2.3%), 123 (3.9%), and 16 (0.5%) of the patients experienced a mild, moderate, severe, and critical disease, respectively. Overall, 332 (10.5%) patients were hospitalized and 50 (1.6%) patients died because of COVID-19 complications. Intake of methotrexate independently predicted COVID-19-associated hospitalization (adjusted OR 2.30; 95% CI 1.11–4.78; p = 0.025). Use of biologic agents was not associated with COVID-19-associated hospitalization (OR 0.75; 95% CI 0.32–1.73; p = 0.491) or mortality (OR 0.85; 95% CI 0.12–6.21; p = 0.870). Older age, the presence of comorbid cardiovascular diseases, metabolic syndrome, chronic obstructive pulmonary disease, and chronic renal failure independently predicted both COVID-19-associated hospitalization and mortality. Conclusions The use of oral methotrexate was associated with an increased odds of COVID-associated hospitalization, whereas the use of biologic drugs was not associated with worse outcomes of COVID-19 among patients with psoriasis. Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00605-8.

Literature Overview of the IL-17 Inhibition from Psoriasis to COVID-19

“…Research by Kridin et al on the impact of immunerelated conditions on the outcomes of COVID-19 found that patients taking biological agents do not influence COVID-19-associated hospitalization or mortality. 16 However in a current large-scale population-based study, compared with methotrexate and ustekinumab, TNFi treatment during the pandemic was associated with a decreased risk of COVID-19 hospitalization. 17 An investigation from northern Italy shows that biological therapies during the pandemic cannot influence the development of severe complications of SARS-CoV-2 infection.…”

Blocking TNF signaling may save lives in COVID-19 infection

“…Therefore, it is reasonable to suggest that many effects of TNF may be blocked at the level downstream of the receptors by NFkB inhibitors. In addition to mTOR inhibitor mentioned earlier, numerous known and potential drugs have been found to inhibit NFkB [ 46 , 47 ]. Aspirin and sodium salicylate inhibit activation of NFkB by blocking IkB kinase [ 48 ].…”

Safety of conventional immunosuppressive therapies for patients with dermatological conditions and coronavirus disease 2019: A review of current evidence

“…Methotrexate use has rarely been linked to more severe COVID‐19 symptoms, with only one case–control study on psoriasis reporting an increased hospitalization risk independently associated with use (adjusted odds ratio, 2.30; 95% CI, 1.11–4.78; p = 0.025) 8 . Methotrexate use has also been associated with a mildly impaired immune response to an mRNA‐based vaccine in a rheumatic disease patient cohort; however, the authors stopped short of recommending postponing or withholding treatment 10 .…”

“…The most severe manifestations of COVID‐19 are thought to result from immune dysregulation and cytokine storm 2,3 . The risk of contracting COVID‐19 and the range of subsequent prognoses for patients receiving immunosuppressive (IS) therapy have not been clearly established; however, observational studies of patients who have an immune‐mediated inflammatory disease (IMID) have demonstrated slightly increased to no change in COVID‐19 susceptibility relative to the general population 4‐8 . Despite this, there remain significant concerns about IS therapy compromising immunity and potentially affecting COVID‐19 susceptibility and morbidity.…”