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Factors associated with adverse COVID-19 outcomes in patients with psoriasis: insights from a global registry-based study

Mahil, Satveer K.; Dand, Nick; Mason, Kayleigh J.; Yiu, Zenas Z. N.; Tsakok, Teresa; Meynell, Freya; Coker, Bola; McAteer, Helen; Moorhead, Lucy; Mackenzie, Teena; Rossi, Maria Teresa; Rivera, Raquel; Mahe, Emmanuel; Carugno, Andrea; Magnano, Michela; Rech, Giulia; Balogh, Esther A.; Feldman, Steven R.; De La Cruz, Claudia; Choon, Siew Eng; Naldi, Luigi; Lambert, Jo; Spuls, Phyllis; Jullien, Denis; Bachelez, Hervé; McMahon, Devon E.; Freeman, Esther E.; Gisondi, Paolo; Puig, Luis; Warren, Richard B.; Di Meglio, Paola; Langan, Sinéad M.; Capon, Francesca; Griffiths, Christopher E. M.; Barker, Jonathan N.; Smith, Catherine H.; study group, PsoProtect

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Authors

Satveer K. Mahil

Nick Dand

Zenas Z. N. Yiu

Teresa Tsakok

Freya Meynell

Bola Coker

Helen McAteer

Lucy Moorhead

Teena Mackenzie

Maria Teresa Rossi

Raquel Rivera

Emmanuel Mahe

Andrea Carugno

Michela Magnano

Giulia Rech

Esther A. Balogh

Steven R. Feldman

Claudia De La Cruz

Siew Eng Choon

Luigi Naldi

Jo Lambert

Phyllis Spuls

Denis Jullien

Hervé Bachelez

Devon E. McMahon

Esther E. Freeman

Paolo Gisondi

Luis Puig

Richard B. Warren

Paola Di Meglio

Sinéad M. Langan

Francesca Capon

Christopher E. M. Griffiths

Jonathan N. Barker

Catherine H. Smith

PsoProtect study group



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.

Journal Article Type Article
Acceptance Date Oct 8, 2020
Online Publication Date Oct 16, 2020
Publication Date 2021-01
Journal Journal of Allergy and Clinical Immunology
Print ISSN 0091-6749
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 147
Issue 1
Pages 60-71
DOI https://doi.org/10.1016/j.jaci.2020.10.007
Keywords COVID-19, biologics, hospitalization, immunosuppressants, psoriasis, risk factors
Publisher URL https://doi.org/10.1016/j.jaci.2020.10.007

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