Factors Associated With Worse COVID-19 Outcomes Among Patients With PsA, axSpA

Severe COVID-19 outcomes in patients with psoriasis (PsO), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) were found to be associated with older age, male sex, greater comorbidity burden, higher disease activity, and glucocorticoid use, according to the results of an international study published in Annals of the Rheumatic Diseases.

Researchers collected information regarding patient demographics, clinical characteristics, and COVID-19 severity from 2 international registries, ie, COVID-19 Global Rheumatology Alliance and Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection.

The primary outcome of the study was COVID-19 severity. The severity scale included 3 categories: no hospitalization or death; hospitalization, but no death; death.

Study participants (N=5045; mean age, 50 years; 51.7% men) included 2295 with PsA (45.5%), 831 with axSpA (36.3%), and 921 with PsO (18.3%).

The majority of patients (82.7%) had disease that was in remission or minimal or low disease activity. A total of 52.9% did not have major comorbidities; the most commonly reported comorbidities were hypertension and obesity (26.5% and 21.1%, respectively). Biologic disease-modifying antirheumatic drug (bDMARD) use was reported in 65.7% and conventional synthetic DMARD (csDMARD) in 30.3% of patients, most commonly methotrexate (23.4%). Nonsteroidal anti-inflammatory drug (NSAID) use was reported in 24% and baseline glucocorticoids in 7.3% of patients.

Of the total cohort, 4220 (83.6%) were not hospitalized and survived; 736 (14.6%) were hospitalized but survived; and 89 (1.8%) died.

Age was associated with COVID-19 severity nonlinearly – the association of age with severe COVID-19 outcomes was more pronounced in older age groups. Cardiometabolic, pulmonary, renal, metabolic, and cancer comorbidities were associated with worse outcomes (odds ratios [ORs], 1.25-2.89). In addition, moderate or high disease activity vs remission or low disease activity, as well as use vs nonuse of glucocorticoids, was associated with increased risk for severe COVID-19 (ORs, 1.39-2.23).

Later in the pandemic (after June 15, 2020), PsO, baseline exposure to tumor necrosis factor inhibitors (TNFi) and interleukin (IL)-17 and IL-12+23 inhibitors were associated with lower risk for severe COVID-19.

The study authors cautioned that reported associations should not be interpreted causally because of the possibility of selection bias and unmeasured confounding. Other study limitations included a possible bias toward those with more severe COVID-19 and those receiving DMARD therapy.

The study authors concluded, “Our findings will help clinicians, scientific societies and policy makers world-wide develop tailored management strategies for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics.”