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

Mahil SK 1 , Dand N 2 , Mason KJ 3 , Yiu ZZN 3 , Tsakok T 1 , Meynell F 1 Show all authors , Coker B 4 , McAteer H 5 , Moorhead L 1 , Mackenzie T 6 , Rossi MT 7 , Rivera R 8 , Mahe E 9 , Carugno A 10 , Magnano M 11 , Rech G 11 , Balogh EA 12 , Feldman SR 12 , De La Cruz C 13 , Choon SE 14 , Naldi L 15 , Lambert J 16 , Spuls P 17 , Jullien D 18 , Bachelez H 19 , McMahon DE 20 , Freeman EE 21 , Gisondi P 22 , Puig L 23 , Warren RB 3 , Di Meglio P 24 , Langan SM 25 , Capon F 26 , Griffiths CEM 3 , Barker JN 24 , Smith CH 27 , PsoProtect study group

Affiliations 

  • 1 St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom
  • 2 Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom; Health Data Research UK, London, United Kingdom
  • 3 Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester Academic Health Science Centre, National Institute for Health Research Manchester Biomedical Research Centre, Manchester, United Kingdom
  • 4 National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • 5 The Psoriasis Association, Northampton, United Kingdom
  • 6 Dermatology Department, Churchill Hospital, Oxford, United Kingdom
  • 7 Dermatology Department, Spedali Civili Hospital, Brescia, Italy
  • 8 Dermatology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain
  • 9 Department of Dermatology, Hôpital Victor Dupouy, Argenteuil, France; Groupe de recherche sur le psoriasis (GrPso) de la Société Française de Dermatologie, Paris, France
  • 10 Dermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
  • 11 Dermatology Unit, Santa Chiara Hospital, Trento, Italy
  • 12 Center for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC
  • 13 Clinica Dermacross, Santiago, Chile
  • 14 Jeffrey Cheah School Of Medicine and Health Sciences, Monash University, Subang Jaya, Selangor
  • 15 Centro Studi GISED, Bergamo, Italy
  • 16 Department of Dermatology, Ghent University, Ghent, Belgium
  • 17 Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands
  • 18 Groupe de recherche sur le psoriasis (GrPso) de la Société Française de Dermatologie, Paris, France; Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France
  • 19 Department of Dermatology, AP-HP Hôpital Saint-Louis, Paris, France; INSERM U1163, Imagine Institute for Human Genetic Diseases, Université de Paris, Paris, France
  • 20 Harvard Medical School, Boston, Mass
  • 21 Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
  • 22 Section of Dermatology and Venereology, University of Verona, Verona, Italy
  • 23 Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
  • 24 St. John's Institute of Dermatology, School of Basic & Medical Biosciences, Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
  • 25 St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom; Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
  • 26 Department of Medical and Molecular Genetics, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
  • 27 St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom. Electronic address: catherine.smith@kcl.ac.uk
J Allergy Clin Immunol, 2021 Jan;147(1):60-71.
PMID: 33075408 DOI: 10.1016/j.jaci.2020.10.007

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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