Factors associated with adverse COVID-19 outcomes in patients with psoriasis—insights from a global registry–based study - 09/01/21
on behalf of the
PsoProtect study group‡
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.
Le texte complet de cet article est disponible en PDF.Key words : COVID-19, hospitalization, psoriasis, risk factors, biologics, immunosuppressants
Abbreviations used : BMI, IBD, IMID, IQR, OR, PsoProtect
Plan
We acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, the NIHR Manchester Biomedical Research Centre and the Psoriasis Association. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. S.K.M. is funded by a Medical Research Council Clinical Academic Research Partnership award (MR/T02383X/1). N.D. is funded by Health Data Research UK (MR/S003126/1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health & Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation; and Wellcome. Z.Z.N.Y is funded by a NIHR Academic Clinical Lectureship through the University of Manchester. C.E.M.G. is an NIHR Emeritus Senior Investigator and is funded in part by the Medical Research Council (MR/101 1808/1). C.E.M.G. and R.B.W. are in part supported by the NIHR Manchester Biomedical Research Centre. S.M.L. is supported by a Wellcome Senior Research Fellowship in clinical science (205039/Z/16/Z). S.M.L. is also supported by Health Data Research UK (grant LOND1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh government), Public Health Agency (Northern Ireland), British Heart Foundation ,and Wellcome Trust. |
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Disclosure of potential conflict of interest: T. Mackenzie has received honoraria from AbbVie, Sanofi, and Leo. C. H. Smith has received departmental research funding from AbbVie, Novartis, Pfizer, and Sanofi and has served as an investigator on Medical Research Council– and Horizon 2020–funded consortia with industry partners (see psort.org.uk and biomap—imi.eu); SOBI provided the drug for a National Institute for Health Research–funded trial in pustular psoriasis. S. K. Mahil has received departmental funding from AbbVie, Celgene, Eli Lilly, Janssen-Cilag, Novartis, Sanofi, and UCB. K. J. Masib has received honoraria from Janssen, LEO Pharma, Lilly, and Novartis. P. Di Meglio has received research grants from UCB and consultancy/speaker honoraria from Novartis, UCB, and Janssen. F. Capon has received funding and consulting fees from Boehringer Ingelheim and AnaptysBio. E. Mahe has received honoraria from AbbVie, Celgene, Amgen, Janssen CIlag, Novartis, Lilly, and Leo Pharma. L. Moorhead has received honoraria from AbbVie, Celgene, Janssen, Leo, Novartis, and UCB. R. Rivera has been a consultant and adviser and/or received speaking fees and/or grants and/or served as an investigator in clinical trials for AbbVie, Almirall, Amgen, Boehringer, Celgene, Janssen, LEO Pharma, Lilly, MSD, Novartis, Pfizer, and UCB. L. Puig has perceived consultancy/speaker honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, Janssen, JS BIOCAD, Leo-Pharma, Lilly, Merck-Serono, MSD, Mylan, Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi, and UCB. J. N. Barker has received honoraria and/or research grants from AbbVie, Almirall, Amgen, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Janssen, Leo, Lilly, Novartis, Samsung, and Sun Pharma. C. E. M. Griffiths has received honoraria and/or research grants from AbbVie, BMS, Almirall, Amgen, Celgene, Eli Lilly Galderma, LEO Pharma, Stiefel GSK, Janssen, MSD, Novartis, Pfizer, Sandoz, Sun Pharmaceuticals, and UCB Pharma. R. B. Warren has received grants and/or honoraria from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Lilly, Leo Pharma, Novartis, Pfizer, Sanofi, UCB Pharma, and Xenoport. S. R. Feldman has received research, speaking and/or consulting support from Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, AbbVie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and the National Psoriasis Foundation; he is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. H. McAteer is employed by the Psoriasis Association, which has received grants from Almirral, AbbVie, Amgen, Celgene, Dermal Laboratories, Eli Lilly, Janssen, LEO Pharma, T and R Derma, and UCB; the Psoriasis Association has a policy that no more than 15% of income can come from the pharmaceutical industry. H. Bachelez has had paid consulting activities for AbbVie, Almirall, Biocad, Boehringer-Ingelheim, Janssen, Kyowa Kirin, Novartis, and UCB, and received grant support from Janssen, Leo Pharma, and Pfizer. D. Jullien has acted as, participated in, or received consultancy for the following: speaker bureau, clinical research, honoraria, scientific officer, steering committees, advisory boards for AbbVie, Almiral Amgen, Biogen, Celgene, Fresenius-Kabi, Janssen-Cilag, Leo, Lilly, MEDAC, Novartis, Pfizer, Sanofi, and UCB. C. De La Cruz has been a speaker or principal investigator for AbbVie, Pfizer, Lilly, Janssen, Novartis, Amgen, Boehringer Ingelheim, and Sanofi. P. Spuls has done consultancies in the past for Sanofi 111017 and AbbVie 041217 (unpaid), received a departmental independent research grant for TREAT NL registry LeoPharma December 2019; he is involved in performing clinical trials with many pharmaceutical industries that manufacture drugs used for the treatment of diseases such as psoriasis and atopic dermatitis, for which financial compensation is paid to the department/hospital; and he is chief investigator of the systemic and phototherapy atopic eczema registry (TREAT NL) for adults and children, as well as one of the main investigators of the SECURE-AD registry. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 147 - N° 1
P. 60-71 - janvier 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.