Abstract
Background: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. Objective: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. Methods: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. Results: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite 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 nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). Conclusion: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19–related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates.
| Original language | English |
|---|---|
| Pages (from-to) | 60-71 |
| Number of pages | 12 |
| Journal | Journal of Allergy and Clinical Immunology |
| Volume | 147 |
| Issue number | 1 |
| Early online date | 16 Oct 2020 |
| DOIs | |
| Publication status | Published - Jan 2021 |
Keywords
- COVID-19
- biologics
- hospitalization
- immunosuppressants
- psoriasis
- risk factors
Fingerprint
Dive into the research topics of 'Factors associated with adverse COVID-19 outcomes in patients with psoriasis - insights from a global registry-based study'. Together they form a unique fingerprint.Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
}
In: Journal of Allergy and Clinical Immunology, Vol. 147, No. 1, 01.2021, p. 60-71.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Factors associated with adverse COVID-19 outcomes in patients with psoriasis - insights from a global registry-based study
AU - PsoProtect study group
AU - Mahil, Satveer K
AU - Dand, Nick
AU - Mason, Kayleigh J
AU - Yiu, Zenas Zn
AU - Tsakok, Teresa
AU - Meynell, Freya
AU - Coker, Bola
AU - McAteer, Helen
AU - Moorhead, Lucy
AU - Mackenzie, Teena
AU - Rossi, Maria Teresa
AU - Rivera, Raquel
AU - Mahe, Emmanuel
AU - Carugno, Andrea
AU - Magnano, Michela
AU - Rech, Giulia
AU - Balogh, Esther A
AU - Feldman, Steven R
AU - De La Cruz, Claudia
AU - Choon, Siew Eng
AU - Naldi, Luigi
AU - Lambert, Jo
AU - Spuls, Phyllis
AU - Jullien, Denis
AU - Bachelez, Hervé
AU - McMahon, Devon E
AU - Freeman, Esther E
AU - Gisondi, Paolo
AU - Puig, Luis
AU - Warren, Richard B
AU - Di Meglio, Paola
AU - Langan, Sinéad M
AU - Capon, Francesca
AU - Griffiths, Christopher Em
AU - Barker, Jonathan N
AU - Smith, Catherine H
N1 - Funding Information: Disclosure of potential conflict of interest: T. Mackenzie has received honoraria from AbbVie, Sanofi, and Leo. C. H. Smith has received departmental research funding from AbbVie, Novartis, Pfizer, and Sanofi and has served as an investigator on Medical Research Council– and Horizon 2020–funded consortia with industry partners (see psort.org.uk and biomap—imi.eu); SOBI provided the drug for a National Institute for Health Research–funded trial in pustular psoriasis. S. K. Mahil has received departmental funding from AbbVie, Celgene, Eli Lilly, Janssen-Cilag, Novartis, Sanofi, and UCB. K. J. Masib has received honoraria from Janssen, LEO Pharma, Lilly, and Novartis. P. Di Meglio has received research grants from UCB and consultancy/speaker honoraria from Novartis, UCB, and Janssen. F. Capon has received funding and consulting fees from Boehringer Ingelheim and AnaptysBio. E. Mahe has received honoraria from AbbVie, Celgene, Amgen, Janssen CIlag, Novartis, Lilly, and Leo Pharma. L. Moorhead has received honoraria from AbbVie, Celgene, Janssen, Leo, Novartis, and UCB. R. Rivera has been a consultant and adviser and/or received speaking fees and/or grants and/or served as an investigator in clinical trials for AbbVie, Almirall, Amgen, Boehringer, Celgene, Janssen, LEO Pharma, Lilly, MSD, Novartis, Pfizer, and UCB. L. Puig has perceived consultancy/speaker honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, Janssen, JS BIOCAD, Leo-Pharma, Lilly, Merck-Serono, MSD, Mylan, Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi, and UCB. J. N. Barker has received honoraria and/or research grants from AbbVie, Almirall, Amgen, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Janssen, Leo, Lilly, Novartis, Samsung, and Sun Pharma. C. E. M. Griffiths has received honoraria and/or research grants from AbbVie, BMS, Almirall, Amgen, Celgene, Eli Lilly Galderma, LEO Pharma, Stiefel GSK, Janssen, MSD, Novartis, Pfizer, Sandoz, Sun Pharmaceuticals, and UCB Pharma. R. B. Warren has received grants and/or honoraria from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Lilly, Leo Pharma, Novartis, Pfizer, Sanofi, UCB Pharma, and Xenoport. S. R. Feldman has received research, speaking and/or consulting support from Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, AbbVie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and the National Psoriasis Foundation; he is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. H. McAteer is employed by the Psoriasis Association, which has received grants from Almirral, AbbVie, Amgen, Celgene, Dermal Laboratories, Eli Lilly, Janssen, LEO Pharma, T and R Derma, and UCB; the Psoriasis Association has a policy that no more than 15% of income can come from the pharmaceutical industry. H. Bachelez has had paid consulting activities for AbbVie, Almirall, Biocad, Boehringer-Ingelheim, Janssen, Kyowa Kirin, Novartis, and UCB, and received grant support from Janssen, Leo Pharma, and Pfizer. D. Jullien has acted as, participated in, or received consultancy for the following: speaker bureau, clinical research, honoraria, scientific officer, steering committees, advisory boards for AbbVie, Almiral Amgen, Biogen, Celgene, Fresenius-Kabi, Janssen-Cilag, Leo, Lilly, MEDAC, Novartis, Pfizer, Sanofi, and UCB. C. De La Cruz has been a speaker or principal investigator for AbbVie, Pfizer, Lilly, Janssen, Novartis, Amgen, Boehringer Ingelheim, and Sanofi. P. Spuls has done consultancies in the past for Sanofi 111017 and AbbVie 041217 (unpaid), received a departmental independent research grant for TREAT NL registry LeoPharma December 2019; he is involved in performing clinical trials with many pharmaceutical industries that manufacture drugs used for the treatment of diseases such as psoriasis and atopic dermatitis, for which financial compensation is paid to the department/hospital; and he is chief investigator of the systemic and phototherapy atopic eczema registry (TREAT NL) for adults and children, as well as one of the main investigators of the SECURE-AD registry. The rest of the authors declare that they have no relevant conflicts of interest. Funding Information: We acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, the NIHR Manchester Biomedical Research Centre and the Psoriasis Association. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. S.K.M. is funded by a Medical Research Council Clinical Academic Research Partnership award (MR/T02383X/1). N.D. is funded by Health Data Research UK (MR/S003126/1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health & Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation; and Wellcome. Z.Z.N.Y is funded by a NIHR Academic Clinical Lectureship through the University of Manchester. C.E.M.G. is an NIHR Emeritus Senior Investigator and is funded in part by the Medical Research Council (MR/101 1808/1). C.E.M.G. and R.B.W. are in part supported by the NIHR Manchester Biomedical Research Centre. S.M.L. is supported by a Wellcome Senior Research Fellowship in clinical science (205039/Z/16/Z). S.M.L. is also supported by Health Data Research UK (grant LOND1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh government), Public Health Agency (Northern Ireland), British Heart Foundation ,and Wellcome Trust. Funding Information: We are very grateful to the health care professionals who have reported cases to the PsoProtect registry and to the patients who have contributed to PsoProtectMe. We would like to acknowledge the professional and patient organizations who supported or promoted the PsoProtect and PsoProtectMe registries (see Table E1). We are grateful for the input of John Weinman, PhD, Lars Iversen, MD, PhD, Professor Nick Reynolds, MD, FRCP, Joel Gelfand, MD MSCE, Hoseah Waweru, MD, Christine Janus, and Michael Kappelman, MD, MPH. We are grateful to Dominic Urmston, Amber Vesty, and Jade Kelly for their support with social media. We are also incredibly thankful to Engine Group UK for their generous creative input and website expertise. The following individuals are health care professionals who have reported cases to the PsoProtect registry (banner author list of PsoProtect study group collaborators): Aadarsh Shah, MRCP, Alberto Barea, MSc, Alberto Romero-Mat?, MD, Alekya Singapore, MD, Alexandra Paolino, MRCP, Alice Mwale, BSc, Ana Maria Morales Callaghan, MD, Ana Mar?a Mart?nez de Salinas, MD, Andrew DeCrescenzo, MD, Andrew E. Pink, MRCP, PhD, Ann Jones, BSc, Ann Sergeant, MD, Annette Essex, RGN, Anthony Bewley, FRCP, Areti Makrygeorgou, MBBS, Astrid van Huizen, MD, Beatriz P?rez-Su?rez, MD, PhD, Benhadou Farida, MD, PhD, Birgitta Wilson Clar?us, MD, Carla Tubau Prims, MD, Carrie Davis, MD, Catherine Quinlan, MRCPI, Catriona Maybury, MRCP, PhD, Gonzalez A. Cesar, MD, Charlotte Barclay, BSc, Claudio Greco, MD, Danielle Brassard, MD, Deanna Cummings, BSc, Deepti Kolli, MD, Vincent Descamps, MD, PhD, Diana Ruiz Genao, MD, Efrossini Carras, BSc, MRCP, Elena Hawryluk, MD, PhD, Eliseo Mart?nez-Garc?a, MD, PhD, Elzbieta Klujszo, MD, Emily Dwyer, BSc, Emmanuel Toni, BSc, Enik? Sonkoly, MD, PhD, Enrique Loayza, MD, Esteban Daud?n, MD, PhD, Fernando Valenzuela, MD, Georgi Popov, MD, PhD, Georgie King, MSc, Girard Celine, MD, Gloria Aparicio, MD, Graham A. Johnston, FRCP, Gustavo Anibal Cardozo, MD, Ian Pearson, MRCP, Ignacio Yanguas, MD, Jamie Weisman, MD, Jennifer E. Carolan, MSc, Jenny Hughes, FRCP, Jose-Maria Ortiz-Salvador, MD, PhD, Jose-Manuel Carrascosa, MD, PhD, Joseph J Schwartz, MD, Karina Jackson, MSc, Kathryn G Kerisit, MD, MPH, Keith Wu, MD, Leila Asfour, MRCP, Leontien de Graaf, MD, C?cile Lesort, MD, Lieve Meuleman, MD, Liv Eidsmo, MD, PhD, Lone Skov, MD, PhD, Lorraine Gribben, BSc, Malcolm Rustin, MD, Manel Velasco, MD, Manisha Panchal, MD, Manpreet Lakhan, MRCP, Manuel D. Franco, MD, Marie-Louise Svensson, BSc, Mark Vandaele, MD, Maruska Marovt, MD, PhD, Omid Zargari, MD, Pablo De Caso, MD, Paulo Varela, MD, Peter Jenkin, MD, FAAD, C?line Phan, MD, Philip Hampton, FRCP, PhD, Portia Goldsmith, MD, FRCP, Rachel Bak, MD, Reinhart Speeckaert, MD, PhD, Ricardo Romiti, MD, PhD, Richard Woolf, MRCP, PhD, Rogelio Mercado-Seda, MD, Rohima Khatun, BSc, Romana Ceovic, MD, Rosa Taberner, MD, Russell W. Cohen, MD, FAAD, Simina Stefanescu, MD, Sarah Kirk, BSc, Saskia Reeken, BSc, Shanti Ayob, MRCP, Silvia P?rez-Barrio, MD, Stefano Piaserico, MD, PhD, Susannah Hoey, MD, Tiago Torres, MD, PhD, Toomas Talme, MD, PhD, Trupti V. Desai, MD, Adrienne J. van Geest, MD, Victoria King, BSc, Vito Di Lernia, MD, Zahira Koreja, BSc, and Vito Zeeshaan Hasab, MBBS. We acknowledge financial support from the Department of Health via the National Institute for Health Research (NIHR) Biomedical Research Centre based at Guy's and St Thomas' NHS Foundation Trust and King's College London, the NIHR Manchester Biomedical Research Centre and the Psoriasis Association. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. S.K.M. is funded by a Medical Research Council Clinical Academic Research Partnership award (MR/T02383X/1). N.D. is funded by Health Data Research UK (MR/S003126/1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council; Economic and Social Research Council; Department of Health & Social Care (England); Chief Scientist Office of the Scottish Government Health and Social Care Directorates; Health and Social Care Research and Development Division (Welsh Government); Public Health Agency (Northern Ireland); British Heart Foundation; and Wellcome. Z.Z.N.Y is funded by a NIHR Academic Clinical Lectureship through the University of Manchester. C.E.M.G. is an NIHR Emeritus Senior Investigator and is funded in part by the Medical Research Council (MR/101 1808/1). C.E.M.G. and R.B.W. are in part supported by the NIHR Manchester Biomedical Research Centre. S.M.L. is supported by a Wellcome Senior Research Fellowship in clinical science (205039/Z/16/Z). S.M.L. is also supported by Health Data Research UK (grant LOND1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh government), Public Health Agency (Northern Ireland), British Heart Foundation, and Wellcome Trust. Disclosure of potential conflict of interest: T. Mackenzie has received honoraria from AbbVie, Sanofi, and Leo. C. H. Smith has received departmental research funding from AbbVie, Novartis, Pfizer, and Sanofi and has served as an investigator on Medical Research Council? and Horizon 2020?funded consortia with industry partners (see psort.org.uk and biomap?imi.eu); SOBI provided the drug for a National Institute for Health Research?funded trial in pustular psoriasis. S. K. Mahil has received departmental funding from AbbVie, Celgene, Eli Lilly, Janssen-Cilag, Novartis, Sanofi, and UCB. K. J. Masib has received honoraria from Janssen, LEO Pharma, Lilly, and Novartis. P. Di Meglio has received research grants from UCB and consultancy/speaker honoraria from Novartis, UCB, and Janssen. F. Capon has received funding and consulting fees from Boehringer Ingelheim and AnaptysBio. E. Mahe has received honoraria from AbbVie, Celgene, Amgen, Janssen CIlag, Novartis, Lilly, and Leo Pharma. L. Moorhead has received honoraria from AbbVie, Celgene, Janssen, Leo, Novartis, and UCB. R. Rivera has been a consultant and adviser and/or received speaking fees and/or grants and/or served as an investigator in clinical trials for AbbVie, Almirall, Amgen, Boehringer, Celgene, Janssen, LEO Pharma, Lilly, MSD, Novartis, Pfizer, and UCB. L. Puig has perceived consultancy/speaker honoraria from and/or participated in clinical trials sponsored by AbbVie, Almirall, Amgen, Baxalta, Biogen, Boehringer Ingelheim, Celgene, Gebro, Janssen, JS BIOCAD, Leo-Pharma, Lilly, Merck-Serono, MSD, Mylan, Novartis, Pfizer, Regeneron, Roche, Sandoz, Samsung-Bioepis, Sanofi, and UCB. J. N. Barker has received honoraria and/or research grants from AbbVie, Almirall, Amgen, Boehringer-Ingelheim, Bristol-Myers Squibb, Celgene, Janssen, Leo, Lilly, Novartis, Samsung, and Sun Pharma. C. E. M. Griffiths has received honoraria and/or research grants from AbbVie, BMS, Almirall, Amgen, Celgene, Eli Lilly Galderma, LEO Pharma, Stiefel GSK, Janssen, MSD, Novartis, Pfizer, Sandoz, Sun Pharmaceuticals, and UCB Pharma. R. B. Warren has received grants and/or honoraria from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Lilly, Leo Pharma, Novartis, Pfizer, Sanofi, UCB Pharma, and Xenoport. S. R. Feldman has received research, speaking and/or consulting support from Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, AbbVie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate, and the National Psoriasis Foundation; he is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients? adherence to treatment. H. McAteer is employed by the Psoriasis Association, which has received grants from Almirral, AbbVie, Amgen, Celgene, Dermal Laboratories, Eli Lilly, Janssen, LEO Pharma, T and R Derma, and UCB; the Psoriasis Association has a policy that no more than 15% of income can come from the pharmaceutical industry. H. Bachelez has had paid consulting activities for AbbVie, Almirall, Biocad, Boehringer-Ingelheim, Janssen, Kyowa Kirin, Novartis, and UCB, and received grant support from Janssen, Leo Pharma, and Pfizer. D. Jullien has acted as, participated in, or received consultancy for the following: speaker bureau, clinical research, honoraria, scientific officer, steering committees, advisory boards for AbbVie, Almiral Amgen, Biogen, Celgene, Fresenius-Kabi, Janssen-Cilag, Leo, Lilly, MEDAC, Novartis, Pfizer, Sanofi, and UCB. C. De La Cruz has been a speaker or principal investigator for AbbVie, Pfizer, Lilly, Janssen, Novartis, Amgen, Boehringer Ingelheim, and Sanofi. P. Spuls has done consultancies in the past for Sanofi 111017 and AbbVie 041217 (unpaid), received a departmental independent research grant for TREAT NL registry LeoPharma December 2019; he is involved in performing clinical trials with many pharmaceutical industries that manufacture drugs used for the treatment of diseases such as psoriasis and atopic dermatitis, for which financial compensation is paid to the department/hospital; and he is chief investigator of the systemic and phototherapy atopic eczema registry (TREAT NL) for adults and children, as well as one of the main investigators of the SECURE-AD registry. The rest of the authors declare that they have no relevant conflicts of interest. Publisher Copyright: © 2020 Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Background: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. Objective: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. Methods: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. Results: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite 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 nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). Conclusion: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19–related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates.
AB - Background: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. Objective: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. Methods: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. Results: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite 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 nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). Conclusion: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19–related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates.
KW - COVID-19
KW - biologics
KW - hospitalization
KW - immunosuppressants
KW - psoriasis
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=85096573101&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2020.10.007
DO - 10.1016/j.jaci.2020.10.007
M3 - Article
C2 - 33075408
SN - 0091-6749
VL - 147
SP - 60
EP - 71
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 1
ER -