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Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey

Quirke-McFarlane, Sophia; Weinman, John; Cook, Emma S; Yiu, Zenas Z N; Dand, Nick; Langan, Sinead M; Bechman, Katie; Tsakok, Teresa; Mason, Kayleigh J; McAteer, Helen; Meynell, Freya; Coker, Bolaji; Vincent, Alexandra; Urmston, Dominic; Vesty, Amber; Kelly, Jade; Lancelot, Camille; Moorhead, Lucy; Barbosa, Ines A; Bachelez, Herve; Capon, Francesca; Contreras, Claudia R; De La Cruz, Claudia; Di Meglio, Paola; Gisondi, Paolo; Jullien, Denis; Lambert, Jo; Naldi, Luigi; Puig, Lluís; Spuls, Phyllis; Torres, Tiago; Warren, Richard B; Waweru, Hoseah; Galloway, James B; Griffiths, Christopher E M; Barker, Jonathan N; Norton, Sam; Smith, Catherine H; Mahil, Satveer K; study group, PsoProtect

Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey Thumbnail


Authors

Sophia Quirke-McFarlane

John Weinman

Emma S Cook

Zenas Z N Yiu

Nick Dand

Sinead M Langan

Katie Bechman

Teresa Tsakok

Helen McAteer

Freya Meynell

Bolaji Coker

Alexandra Vincent

Dominic Urmston

Amber Vesty

Jade Kelly

Camille Lancelot

Lucy Moorhead

Ines A Barbosa

Herve Bachelez

Francesca Capon

Claudia R Contreras

Claudia De La Cruz

Paola Di Meglio

Paolo Gisondi

Denis Jullien

Jo Lambert

Luigi Naldi

Lluís Puig

Phyllis Spuls

Tiago Torres

Richard B Warren

Hoseah Waweru

James B Galloway

Christopher E M Griffiths

Jonathan N Barker

Sam Norton

Catherine H Smith

Satveer K Mahil

PsoProtect study group



Abstract

Background Nonadherence 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 nonadherence to immune-modifying therapy during the pandemic. Objectives To assess the extent of and reasons underlying nonadherence to systemic immune-modifying therapy during the COVID-19 pandemic in individuals with psoriasis, and the association between mental health and nonadherence. 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 nonadherence 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 nonadherence during the pandemic, most commonly due to concerns about their immunity. In the unadjusted model, a positive anxiety screen was associated with nonadherence to systemic immune-modifying therapy [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.07–1.76]. Specifically, anxiety was associated with nonadherence 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 nonadherence 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 nonadherence 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). Conclusions These data indicate substantial nonadherence 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 nonadherence. 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 optimize adherence and disease outcomes.

Journal Article Type Article
Acceptance Date Dec 17, 2022
Online Publication Date Dec 23, 2022
Publication Date 2023-05
Publicly Available Date Mar 29, 2024
Journal British Journal of Dermatology
Print ISSN 0007-0963
Electronic ISSN 1365-2133
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 188
Issue 5
Pages 610-617
DOI https://doi.org/10.1093/bjd/ljac144
Keywords Dermatology
Publisher URL https://academic.oup.com/bjd/advance-article/doi/10.1093/bjd/ljac144/6957428
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.

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