Factors associated with adverse COVID-19 outcomes in patients with psoriasis—insights from a global registry–based study

Abstract

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.

Risk mitigating behaviours in people with inflammatory joint and skin disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey

“…In contrast, the standard systemics sulfasalazine or 5-aminosalicylate were associated with a higher risk of hospitalization or death. Our previously published study of 374 patients with psoriasis and COVID-19 reported to the PsoProtect registry further suggested an association between biologics (pooled data on TNF, IL-17 and IL-23 inhibitors) and reduced risk of hospitalization, compared to standard systemic therapies 18 . Although exploration of possible biological mechanisms underlying these associations is warranted (e.g.…”

“…Patients on combination targeted and standard systemic therapy were included in the targeted therapy group, and surveys with missing treatment data were excluded. Apremilast was included in the standard systemic therapy group since in clinician-reported registry analyses, it was not grouped with biologics (unlike JAK inhibitors) 17,18 .…”

“…Global clinician-reported registry data in rheumatic diseases, psoriasis and inflammatory bowel disease have further suggested a differential risk of severe COVID-19 associated with different treatment types. In particular, use of targeted systemic therapies (biologics and Janus Kinase [JAK] inhibitors) was associated with a reduced risk of adverse COVID-19 outcomes, compared with no treatment or standard systemic agents 16–18 . It remains unclear if this is attributable to therapeutic modulation of the host antiviral immune and inflammatory response (i.e.…”

Impact of the COVID-19 pandemic on children with psoriasis

“…Since none of the seven children exposed to or contracting COVID-19 were receiving immunosuppressive treatments, our study does not provide new data on the risk of severe COVID-19 in children being treated with these drugs. Data about the risk of severe COVID-19 in adult patients with psoriasis receiving biologic therapies are quite reassuring [5] , [6] , [17] and there is currently no reason to stop these treatments in children during the pandemic, as proposed in both the international and French recommendations [11] , [12] . Nevertheless, nearly 20% of the children stopped their systemic treatment.…”

“…These children may require general immunosuppressive treatments or biotherapies [16] . A limited amount of data has been published about adults with psoriasis during the COVID-19 pandemic, but none that are specific to children [5] , [6] , [7] , [10] , [17] . However, the COVID-19 pandemic and the resulting preventive health measures are likely to have affected children with psoriasis in many ways: flare-ups in case of infection, stress, or discontinuation of treatment, problems with medical follow-up, and more severe forms of COVID-19 infection in children treated with immunosuppressive agents.…”