Biologics Reduce COVID-19 Hospitalization Risk in Psoriasis

By Reuters Staff

October 28, 2020

NEW YORK (Reuters Health) - Biologic treatment in patients with psoriasis is associated with a reduced risk of COVID-19-related hospitalization, compared with non-biologic systemic therapies, according to a new registry study.

Psoriasis, rheumatoid arthritis, and systemic lupus erythematosus have been highlighted as potential risk factors for COVID-19-related death, but the risk attributable to psoriasis alone or its therapies remains uncertain.

Dr. Catherine Smith of Guy's and St. Thomas' NHS Foundation Trust, in London, and colleagues used data from the clinician-reported Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect) and the self-report patient-facing registry PsoProtectMe to identify demographic and clinical factors associated with COVID-19-related hospitalization.

The median age of the 374 psoriasis patients from 25 countries who had confirmed or suspected COVID-19 was 50 years, almost all had plaque psoriasis (98%), and the majority had clear/nearly clear/mild psoriasis at COVID-19 onset.

More than two-thirds (71%) were receiving a biologic treatment, 18% were receiving a non-biologic systemic agent, and 10% were receiving no systemic therapy.

Overall, 21% of patients were hospitalized for COVID-19 for a median 11 days, 2% required high flow oxygen supplementation, and 3% required mechanical ventilation.

Nine patients, all of whom had at least one comorbidity, died at ages ranging from 43 to 89 years.

After adjusting for potential confounding factors, non-biologic treatment was associated with a significant 2.84-fold increase in the odds of hospitalization, compared with biologic treatment, the researchers report in the Journal of Allergy and Clinical Immunology.

Patients receiving no systemic therapy had a similarly increased risk of hospitalization relative to those receiving biologics that fell short of statistical significance.

Among the classes of biologics, hospitalization was more common in patients receiving IL-23 inhibitors (23%) than in those receiving TNF inhibitors (14%) or IL-17 inhibitors (13%), but the 95% confidence intervals of the odds ratios were wide and included 1.0.

Other significant independent predictors of increased hospitalization rate included advancing age, male sex, nonwhite ethnicity, and comorbid chronic lung disease.

Patients treated with biologics were more likely than those receiving non-biologic systemic therapies to report social isolation and slightly less likely to report stopping treatment during the pandemic.

"The accumulation of further data is required to clarify these observations before any recommendations for changes in clinical practice can be considered," the authors conclude. "Possible selection bias should be addressed through robust global clinician and patient participation in COVID-19 registries and alternative study designs such as cohort studies."

"This will open avenues for characterizing the determinants of additional COVID-19 outcomes and the impacts of specific treatments at higher resolution," they write.

The study did not have commercial funding, but several authors reported ties to one or more pharmaceutical manufacturers of biologics or other psoriasis treatments.

Dr. Smith did not respond to a request for comments.

SOURCE: Journal of Allergy and Clinical Immunology, online October 16, 2020.