The Risk of COVID-19 Pandemic in Patients with Moderate to Severe Plaque Psoriasis Receiving Systemic Treatments

Abstract

Chronic plaque psoriasis is an inflammatory skin disease affecting 2–3% of the general population. Approximately one-third of patients are candidates for systemic immunosuppressive treatments, such as synthetic or biological disease-modifying antirheumatic drugs, because of disease extensions, localization in sensitive or visible areas and/or resistance to topical treatments. These therapies have been associated with increased risk of infection, including upper respiratory tract viral infection. Psoriasis is frequently associated with cardio-metabolic comorbidities, such as obesity and diabetes, that are risk factors for poor prognosis in the case of coronavirus disease (COVID-19) pneumonia. A narrative review of the literature based on an electronic search of the PubMed® database was undertaken with the objective of investigating whether there is an increased risk of COVID-19 infection in psoriasis patients on systemic treatment. Original articles, such as case reports, published up to 1 November 2020 were included. There is no evidence that patients with moderate-to-severe psoriasis receiving systemic treatments, including biologics, have higher risk of SARS-CoV-2 infection and/or increased hospitalization and death related to COVID-19 compared to the general population. Several case reports described full recovery from COVID-19 with favorable outcomes in psoriasis patients who were being treated with synthetics or biologicals. Nonetheless, caution should be maintained in this setting, and more data are needed to draw definitive conclusions.

National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: Version 2—Advances in psoriatic disease management, COVID-19 vaccines, and COVID-19 treatments

“…[4][5][6][7][8] Nevertheless, patients with psoriatic disease appear to have similar rates of infection with SARS-CoV-2 and COVID-19 outcomes as the general population, with multiple new studies from Italy, which primarily focused on patients with psoriasis receiving oral or biologic treatment, supporting our initial recommendation (guidance 1.1). [9][10][11] Additional new studies of patients with psoriatic arthritis (PsA) nested within cohorts of patients with rheumatic disease also suggest that they have similar rates of infection with SARS-CoV-2 and COVID-19 outcomes as the general population. [12][13][14] However, the risk of COVID-19 in autoimmune diseases was higher than in control patients (odds ratio [OR], 2.19; 95% confidence interval [CI], 1.05-4.58) in a meta-analysis of 7 case-control studies.…”

COVID-19 illness and autoimmune diseases: recent insights

“…Using randomized clinical trials (compared overall infection rates, rates of upper respiratory infections and nasopharyngitis), Lebwohl et al have found that the rates of nasopharyngitis and upper respiratory tract infections are similar to placebo [ 160 ]. Similarly, compared to the general population, there is no increased susceptibility for SARS-CoV-2 infection or increased severity of the disease course of COVID-19 in patients with psoriasis receiving systemic treatments, including biologics [ 161 ]. These studies suggested that biological therapy should be continued in patients with immune-mediated skin diseases during the COVID-19 outbreak.…”

Dermatologists’ attitude towards psoriasis treatment during the COVID-19 pandemic

“… 6 Although the impact of these therapeutic options on increasing the risk of SARS-CoV-2 infection and disease severity remained somewhat uncertain for a long period, national and international guidelines on the topic were gradually updated based on the clinical experience. 7 – 11 More recently, guidelines on the appointment structure (in-person versus virtual), prioritization of clinical admissions (urgent versus less urgent), and the frequency of visits have also been developed. 7 – 12…”

“… 7 – 11 More recently, guidelines on the appointment structure (in-person versus virtual), prioritization of clinical admissions (urgent versus less urgent), and the frequency of visits have also been developed. 7 – 12…”