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Published on: March 1, 2024
Factors associated with adverse COVID-19 outcomes in patients with psoriasis-insights from a global registry-based
Satveer K Mahil1, Nick Dand2, Kayleigh J Mason3
1St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.
Insights
Patients with psoriasis on biologic treatments had a lower risk of COVID-19 hospitalization compared to those on nonbiologic therapies. Established risk factors like older age and male sex increased hospitalization risk.
Area of Science:
- Dermatology
- Infectious Diseases
- Epidemiology
Background:
- Psoriasis patients on immunosuppressants may face higher risks from COVID-19.
- Limited data exists on COVID-19 outcomes in this population.
Purpose of the Study:
- Characterize COVID-19 course in psoriasis patients.
- Identify factors linked to COVID-19 hospitalization.
Main Methods:
- International registry (Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection) used.
- Clinician-reported cases of confirmed/suspected COVID-19 in psoriasis patients.
- Logistic regression analyzed hospitalization risk factors.
Main Results:
- Biologic therapy associated with lower hospitalization risk than nonbiologic therapy.
- Older age, male sex, nonwhite ethnicity, and lung disease increased hospitalization risk.
- No significant difference in hospitalization risk among biologic classes.
Conclusions:
- Biologic use linked to reduced COVID-19 hospitalization compared to nonbiologics.
- Traditional risk factors (age, sex, ethnicity, comorbidities) remain significant.
- Further research needed due to potential biases in observational data.
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.
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