Quirke-McFarlane, S, Weinman, J, Cook, ES, Yiu, ZZN, Dand, N, Langan, SM, Bechman, K, Tsakok, T, Mason, KJ, McAteer, H, Meynell, F, Coker, B, Vincent, A, Urmston, D, Vesty, A, Kelly, J, Lancelot, C, Moorhead, L, Barbosa, IA, Bachelez, H, Capon, F, Contreras, CR, De La Cruz, C, Di Meglio, P, Gisondi, P, Jullien, D, Lambert, J, Naldi, L, Puig, L, Spuls, P, Torres, T, Warren, RB, Waweru, H, Galloway, JB, Griffiths, CEM, Barker, JN, Norton, S, Smith, CH, Mahil, SK and study group, PsoProtect (2022) Non-adherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey. British Journal of Dermatology. ISSN 1365-2133

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BACKGROUND: Non-adherence to immune-modifying therapy is a complex behaviour which, before the COVID-19 pandemic, was shown to be associated with mental health disorders in people with immune-mediated diseases. The COVID-19 pandemic has led to a rise in the global prevalence of anxiety and depression, and limited data exist on the association between mental health and non-adherence to immune modifying therapy during the pandemic. OBJECTIVES: To assess the extent of and reasons underlying non-adherence to systemic immune-modifying therapy during the COVID-19 pandemic in individuals with psoriasis, and the association between mental health and non-adherence. METHODS: Online self-report surveys (PsoProtectMe), including validated screens for anxiety and depression, were completed globally during the first year of the pandemic. We assessed the association between anxiety or depression and non-adherence to systemic immune-modifying therapy using binomial logistic regression, adjusting for potential cofounders (age, sex, ethnicity, comorbidity), and country of residence. RESULTS: Of 3980 participants from 77 countries, 1611 (40.5%) were prescribed a systemic immune-modifying therapy. Of these, 408 (25.3%) reported non-adherence during the pandemic, most commonly due to concerns about their immunity. In the unadjusted model, a positive anxiety screen was associated with non-adherence to systemic immune-modifying therapy (OR 1.36, 95%CI 1.07-1.76). Specifically, anxiety was associated with non-adherence to targeted therapy (OR 1.41, 95%CI 1.01-1.96) but not standard systemic therapy (OR 1.16, 95%CI 0.81-1.67). In the adjusted model, although the directions of the effects remained, anxiety was not significantly associated with non-adherence to overall systemic (OR 1.20, 95%CI 0.92-1.56) or targeted (OR 1.33, 95%CI 0.94-1.89) immune-modifying therapy. A positive depression screen was not strongly associated with non-adherence to systemic immune-modifying therapy in the unadjusted (OR 1.22, 95% CI 0.94-1.57) or adjusted models (OR 1.14, 95% CI 0.87-1.49). CONCLUSION: These data indicate substantial non-adherence to immune-modifying therapy in people with psoriasis during the pandemic, with attenuation of the association with mental health after adjusting for confounders. Future research in larger populations should further explore pandemic-specific drivers of treatment non-adherence. Clear communication of the reassuring findings from population-based research regarding immune-modifying therapy-associated adverse COVID-19 risks to people with psoriasis is essential, to optimise adherence and disease outcomes.

Item Type: Article
Additional Information: © The Author(s) 2022. Published by Oxford University Press on behalf of British Association of Dermatologists. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Subjects: R Medicine > R Medicine (General)
Divisions: Faculty of Medicine and Health Sciences > School of Medicine
Related URLs:
Depositing User: Symplectic
Date Deposited: 16 Mar 2023 09:54
Last Modified: 16 Mar 2023 09:54
URI: https://eprints.keele.ac.uk/id/eprint/12018

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