Mahil, SK, Dand, N, Mason, KJ, Yiu, ZZ, Tsakok, T, Meynell, F, Coker, B, McAteer, H, Moorhead, L, Mackenzie, T, Rossi, MT, Rivera, R, Mahe, E, Carugno, A, Magnano, M, Rech, G, Balogh, EA, Feldman, SR, De La Cruz, C, Choon, SE, Naldi, L, Lambert, J, Spuls, P, Jullien, D, Bachelez, H, McMahon, DE, Freeman, EE, Gisondi, P, Puig, L, Warren, RB, Di Meglio, P, Langan, SM, Capon, F, Griffiths, CE, Barker, JN and Smith, CH (2020) Factors associated with adverse COVID-19 outcomes in patients with psoriasis: insights from a global registry-based study. Journal of Allergy and Clinical Immunology.

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

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Abstract

BACKGROUND: The multi-morbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse COVID-19 outcomes but data are limited. OBJECTIVE: Characterize the course of COVID-19 in psoriasis and identify factors associated with hospitalization. METHODS: Clinicians reported psoriasis patients with confirmed/suspected COVID-19 via an international registry, PsoProtect. Multiple logistic regression assessed the association between clinical/demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviours. RESULTS: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% a non-biologic and 10% no systemic treatment for psoriasis. 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted OR 1.59 per 10 years, 95% CI 1.19-2.13), male sex (OR 2.51, 95% CI 1.23-5.12), non-white 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 non-biologic systemic therapy than biologics (OR 2.84, 95% CI 1.31-6.18). No significant differences were found between biologic classes. Independent patient-reported data (n=1,626 across 48 countries) suggested lower levels of social isolation in individuals receiving non-biologic systemic therapy compared to biologics (OR 0.68, 95% CI 0.50-0.94). CONCLUSION: In this international moderate-severe psoriasis case series, biologics use was associated with lower risk of COVID-19-related hospitalization than non-biologic systemic therapies, however further investigation is warranted due to potential selection bias and unmeasured confounding. Established risk factors (being older, male, non-white ethnicity, comorbidities) were associated with higher hospitalization rates. CLINICAL IMPLICATIONS: We identify risk factors for COVID-19-related hospitalization in psoriasis patients, including older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic therapies.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://doi.org/10.1016/j.jaci.2020.10.007 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: COVID-19, biologics, hospitalization, immunosuppressants, psoriasis, risk factors
Subjects: R Medicine > RC Internal medicine > RC705 Diseases of the respiratory system
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Depositing User: Symplectic
Date Deposited: 04 Nov 2020 10:10
Last Modified: 21 Nov 2020 13:00
URI: https://eprints.keele.ac.uk/id/eprint/8872

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