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

Abstract

Objectives Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. Methods Online surveys were completed by individuals with Rheumatic and Musculoskeletal Diseases (RMD) (UK only) or psoriasis (globally) between 4th May and 7th September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterised international variation in a mixed effects model. Results Of 3,720 participants (2,869 psoriasis, 851 RMD) from 74 countries, 2,262 (60.8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term shielding). A greater proportion of those receiving targeted therapies (biologics and JAK inhibitors) reported shielding compared to those receiving no systemic therapy (adjusted odds ratio [OR] 1.63, 95% CI 1.35-1.97) and standard systemic agents (OR 1.39, 95% CI 1.22-1.56). Shielding was associated with established risk factors for severe COVID-19 (male sex [OR 1.14, 95% CI 1.05-1.24], obesity [OR 1.38, 95% CI 1.23-1.54], comorbidity burden [OR 1.43, 95% CI 1.15-1.78]), a primary indication of RMD (OR 1.37, 95% CI 1.27-1.48) and a positive anxiety or depression screen (OR 1.57, 95% CI 1.36-1.80). Modest differences in the proportion shielding were observed across nations. Conclusions Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk mitigation strategies and may help inform updated public health guidelines as the pandemic continues.

Immediate effect of the COVID-19 pandemic on patient health, health-care use, and behaviours: results from an international survey of people with rheumatic diseases

“…Other studies have found that those with rheumatic disease are more likely to isolate than are matched friends or family controls, 17 and that people taking biologic drugs are more likely to practice shielding (ie, to quarantine) than are those not taking biologics. 18 Whether or not people with rheumatic disease are at increased risk of infection or complications than the general population remains unclear. 19,20 People with rheumatic diseases might be more likely to be tested for COVID-19 because of their underlying diagnoses, thus creating biases in the outcomes of many studies.…”

Perceived Risk and Associated Shielding Behaviors in Patients With Rheumatoid Arthritis During the Coronavirus 2019 Pandemic

“…Hypertension was the most common comorbidity (142; 29%) and the median (IQR) CCI was 1.0 (1.0‐2.0). The median (IQR) number of health care visits within the MGB system in the last 6 months of 2019 (July 1, 2019, to December 31, 2019), preceding the pandemic, was 16 ( 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ). At the time of the survey, the mean (SD) disease activity was 74.6 (19.9).…”

Treatment of psoriasis with biologics in the early COVID‐19 pandemic: A study examining patient attitudes toward the treatment and disease course

“…The risk-mitigating behaviors of patients with psoriasis who use biological agents are reported to be greater than those who use non-biological systemic therapy and those who do not use systemic therapy. 18,19 In a study including 1626 patients with psoriasis by Mahil et al, compliance with social or individual isolation measures was reported as 72% in patients with psoriasis using biological agents, and 63% in patients using non-biological systemic therapy and not using systemic therapy. 18 In the same study, the rate of those who did not comply with general virus protection measures was reported as 0.4% in patients with psoriasis using biological agents whereas 0.8% using non-biological systemic therapy and 0.9% in patients not using systemic therapy.…”