Psoriasis patients who use biologics are protected against severe COVID-19


By Mardi Chapman

28 Oct 2020

COVID-19 outcomes are better in people with psoriasis who use biologic therapy rather than non-biologic therapy to manage their skin condition, research shows.

International data from the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 infecTion (PsoProtect) and the self-reporting patient-facing registry PsoProtectMe was supplemented by cases from two US registries SECURE-Psoriasis and AAD COVID-19.

The study identified 374 psoriasis patients with confirmed (46%) or clinically suspected (54%) COVID-19 from 25 countries. Most patients were from the UK (36%), Italy (21%) and Spain (15%), most were males (61%) and most were of white ethnicity (85%).

Most patients were receiving a biologic treatment (71%) for their psoriasis rather than a non-biologic systemic agent such as acitretin, apremilast, ciclosporin, methotrexate, fumaric acid esters/dimethylfumarate and prednisolone (18%) or no systemic therapy (10%).

The study, led by Professor Catherine Smith from St John’s Institute of Dermatology in the UK, found hospitalisation rates in the patients on biologic therapy (17%) were half those of patients taking other treatments (34%) and less than patients on no systemic treatment (29%).

There were also fewer cases of mechanical ventilation (2% v 5%) and deaths (3% v 5%) in patients on biologics versus other systemic treatment.

“In the fully adjusted model, non-biologic systemic therapy for psoriasis remained associated with increased risk of hospitalisation compared with the group of biologic users (OR 2.84, 95% CI 1.31-6.18). Patients receiving no systemic therapy were estimated to have a similarly increased risk of hospitalisation (OR 2.35, 95% CI 0.82-6.72),” the study said.

“This suggests that use of biologics is associated with a reduced risk of hospitalisation compared with either non-biologic systemic therapy or no therapy, although interpretation of these estimates should take into account possible sources of bias.”

“Given the cytokine upregulation from aberrant immune activation observed in severe COVID-19, there is biological plausibility for a protective effect of cytokine-targeted biologics on adverse outcomes, compared with broader immunosuppressants that may detrimentally suppress host anti-viral immunity.”

The study authors said it was possible there were unmeasured confounders driving their findings such as potentially different COVID-19 risk-mitigating behaviours (e.g. social isolation, treatment adherence) between the psoriasis treatment groups.

They also noted a higher rate of hospitalisation among patients using IL-23 inhibitors (23%) compared with TNF inhibitors (14%) or IL-17 inhibitors (13%) but said larger datasets were warranted.

As seen in other COVID-19 cohorts, older age (OR 1.59), male gender ((OR 2.51), and non-white ethnicity (OR 3.15) were risk factors for hospitalisation in psoriasis patients.

“Comorbidities were also highly prevalent: 76% of hospitalised patients were reported to have hypertension, cardiovascular disease, diabetes, chronic liver disease or chronic lung disease (including asthma), compared to 34% of non-hospitalised patients.”

The study said their findings were consistent with other COVID-19 registries where, for example, TNF inhibitor use was associated with decreased risk of hospitalisation among patients with rheumatic disease and decreased risk of hospitalisation or death in inflammatory bowel disease.

The study was published in the Journal of Allergy and Clinical Immunology.

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