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

Satveer K. Mahil, Nick Dand, Kayleigh J. Mason, Zenas Z.N. Yiu, Teresa Tsakok, Freya Meynell, Bola Coker, Helen McAteer, Lucy Moorhead, Teena Mackenzie, Maria Teresa Rossi, Raquel Rivera, Emmanuel Mahe, Andrea Carugno, Michela Magnano, Giulia Rech, Esther A. Balogh, Steven R. Feldman, Claudia De La Cruz, Siew Eng ChoonLuigi Naldi, Jo Lambert, Phyllis Spuls, Denis Jullien, Hervé Bachelez, Devon E. McMahon, Esther E. Freeman, Paolo Gisondi, Luis Puig, Richard B. Warren, Paola Di Meglio, Sinéad M. Langan, Francesca Capon, Christopher E.M. Griffiths, Jonathan N. Barker, Catherine H. Smith*, PsoProtect study group, Aadarsh Shah, Alberto Barea, Alberto Romero-Maté, Alekya Singapore, Alexandra Paolino, Alice Mwale, Ana Maria Morales Callaghan, Ana Martinez, Andrew DeCrescenzo, Andrew E. Pink, Ann Jones, Ann Sergeant, Annette Essex, Lone Skov (Member of study group)

*Corresponding author for this work
131 Citations (Scopus)

Abstract

Background: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. Objective: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. Methods: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. Results: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite 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 nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). Conclusion: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19–related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates.

Original languageEnglish
JournalJournal of Allergy and Clinical Immunology
Volume147
Issue number1
Pages (from-to)60-71
Number of pages12
ISSN0091-6749
DOIs
Publication statusPublished - Jan 2021

Keywords

  • biologics
  • COVID-19
  • hospitalization
  • immunosuppressants
  • psoriasis
  • risk factors

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