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

Abstract

Background Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. Objectives 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 psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 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 characterized international variation in a mixed-effects model. Results Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60Á8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1Á63, 95% confidence interval (CI) 1Á35-1Á97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1Á39, 95% CI 1Á23-1Á56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1Á14, 95% CI 1Á05-1Á24), obesity (OR 1Á37, 95% CI 1Á23-1Á54), comorbidity burden (OR 1Á43, 95% CI 1Á15-1Á78)], a primary indication of RMDs (OR 1Á37, 95% CI 1Á27-1Á48) and a positive anxiety or depression screen (OR 1Á57, 95% CI 1Á36-1Á80). 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.

Risk of COVID‐19 infection in adult patients with atopic eczema and psoriasis: a single‐centre cross‐sectional study

“…It has been shown that people with psoriasis receiving targeted biological and systemic therapies are likely to follow the most stringent risk-mitigating behaviours. 5 In conclusion, psoriasis and AE were not associated with an increased risk of testing positive for COVID-19. On this evidence, it appears that psoriasis and AE should not be considered as risk factors for contracting COVID-19.…”

“…C. Pan, 1,2 A. Humbatova, 3 L. Zheng, 1,2 N. Cesarato, 3 C. Grimm, 4 F. Chen, 1,2 B. Blaumeiser, 5 A. Catal an-Lamb an, 6 A. Patiño-Garc ıa, 6 U. Fischer, 4 R. Cheng, 1 Y. Li, 1,2 X. Yu, 1 Z. Yao iD , 1,2 M. Li iD 1,2,7 and R.C. Betz iD 3…”

Describing the burden of the COVID‐19 pandemic in people with psoriasis: findings from a global cross‐sectional study

“…Exanthems due to viral infections typically present within 14 days of viral symptom onset. 4 Skin rashes in COVID-19 are believed to present around the same time as other symptoms, typically during the first few days of fever and respiratory symptoms. 1 In this cohort, only a minority of exanthems (n = 7/39; 17.9%) developed within 14 days of COVID-19 symptom onset to be considered for a viral rash.…”

Outcomes of patients with chronic plaque psoriasis and hidradenitis suppurativa on biologic therapy during the Covid‐19 pandemic: A UK dermatology tertiary centre experience

“…Shielding behaviour is likely to have contributed to the lower risk of adverse Covid-19 outcomes and is likely to be an important potential mediator in these groups of patients as suggested by the PsoProtect and CORE-UK study groups. 8…”

“…Whilst we did not compare outcomes of patients who had psoriasis/ HS on biologics to those on other systemics only, out of 25 (15.2%) psoriasis patients on additional systemic medications, none tested positive for Covid-19 infection. Shielding behaviour is likely to have contributed to the lower risk of adverse Covid-19 outcomes and is likely to be an important potential mediator in these groups of patients as suggested by the PsoProtect and CORE-UK study groups 8.…”