Jörg C. Prinz, MD
Ludwig Maximilians University
Factors associated with adverse COVID-19 outcomes in patients with psoriasis – insights from a global registry-based study. Satveer K. Mahil, Nick Dand, Kayleigh J. Mason, Zenas ZN. 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 EM. Griffiths, Jonathan N. Barker, Catherine H. Smith. J Allergy Clin Immunol. 2020 Oct 16; S0091-6749(20)31413-5. doi: 10.1016/j.jaci.2020.10.007. [Epub ahead of print]
Most systemic treatments for psoriasis involve an increased risk of severe infections. Thus, at the beginning of the Covid-19 pandemic, the question arose whether systemic therapy of psoriasis with conventional (cs) or biological systemic (bs) DMARDs worsens the prognosis for a Covid-19 infection. Numerous medical societies, including dermatological societies, have therefore called for special caution in the beginning of the pandemic when using DMARDs for treatment. In addition, a worldwide dermatological registry, PsoProtect, has been established to assess the course of Covid-19 infections, documenting the course and outcome of Covid-19 infections in psoriasis patients.
Now a first thorough evaluation of this register data is available. The data analysis is complemented by data from two U.S. Covid-19 registries and the self-report patient-facing registry, PsoProtectMe. The main criterion for the severity of the infection was the need for hospitalization. The course of the disease was evaluated comparatively for the different forms of therapy and for the presence of concomitant diseases.
The registry data of 374 patients reveal that treatment with bsDMARDS is associated with a lower risk of Covid-19-related hospitalization compared to treatment with csDMARDs. Psoriasis patients treated with csDMARDs and those without systemic therapy had an equal risk of hospitalization within the patient population. This implies that csDMARDs do not increase the risk of severe Covid-19 events. Significant risk factors for hospitalization were the same as for the normal population: concomitant diseases, male gender and non-white ethnicity.
These results of this highly topical study have important consequences for decision regarding the treatment of psoriasis patients. They show that systemic therapy for psoriasis does not increase the risk of severe Covid-19 infections. Blocking cytokines, especially TNF-α and IL-17, even seems to have a protective effect. These conclusions are supported by a register study on the course of Covid-19 infections in patients with rheumatological diseases (Gianfrancesco et al., 2020). Again, besides therapy with systemic glucocorticosteroids, concomitant diseases and age were the actual risk factors for hospitalization, while both bsDMARDs and csDMARDs in this study rather reduced the risk of severe Covid-19 infection.
An important conclusion from this study is therefore: The decision to initiate or maintain systemic therapy of psoriasis can be made independently of the Covid-19 pandemic. Systemic therapy of psoriasis does not pose a risk of severe Covid-19 infections.
Gianfrancesco M, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79:859–866. doi:10.1136/annrheumdis-2020-217871