Risk for Severe COVID-19 Low in Patients With Psoriatic Disease

Patients with psoriatic arthritis (PsA) and psoriasis (PsO) receiving immunomodulatory therapy are not at higher risk for severe COVID-19 outcomes, according to study results published in JAAD International.

The aim of the study was to report on COVID-19 outcomes among patients with psoriatic disease who were enrolled in the Web-based Assessment of Autoimmune, Immune-Mediated, and Rheumatic Patients during the COVID-19 Pandemic (WARCOV) study.

A study cohort including adults with PsO and/or PsA were enrolled from New York University Langone Health and the New York City Health + Hospitals/Bellevue. Study participants were followed up from March 2020 through July 2020 and were referred either by a rheumatologist or a dermatologist. Some patients had previously consented to be contacted for research purposes.

A total of 173 patients with PsO and/or PsA were included in the current analysis, of whom 58 (33.5%) contracted COVID-19. Of the 58 participants, 40 were confirmed to have COVID-19 and 18 had a high index of suspicion for having contracted COVID-19. The majority of patients (81%) had mild disease and were managed at home or in an outpatient setting. Overall, 11 (19%) of patients who developed COVID-19 were hospitalized for severe disease, which included 4 patients who received treatment on the hospital floor and 6 patients who needed intensive care.

Four (6.9%) patients died from COVID-19-related complications, all of whom had preexisting risk factors for severe infection; 2 patients had high-risk exposures to a health care setting.

Researchers did not note significant differences in sex, age, and underlying psoriatic disease of the control participants, the study participants, and the patients with severe infection.

The presence of hypertension (odds ratio [OR], 5.15; 95% CI, 1.11-22.26; P =.28) and a higher body mass index (OR, 1.13; 95% CI, 1.04-1.24; P =.005) was associated with a significantly increased likelihood of severe outcomes from COVID-19. Further, the use of interleukin (IL)-12/23 or IL-23 inhibitor treatment was linked to a significantly increased risk for COVID-19 (OR, 3.64; 95% CI, 1.29-10.86; P =.16), but not to an increased risk for severe COVID-19 outcomes. Treatment with methotrexate, oral glucocorticoids, apremilast, tumor necrosis factor (TNF)-alpha inhibitors, and IL-17 inhibitors did not have an impact on outcomes from COVID-19.

The rate of hospitalization in the study cohort was similar to that in the general New York City population (ie, 21%) at the time of data capture, thus implying that the presence of psoriatic disease alone may not indicate an increased risk of developing severe COVID-19 outcomes.

Because of the low incidence of COVID-19 in this study, referred patients provided an adequate number for a meaningful statistical analysis, which may have been a source of potential selection bias. The association between IL-12/23 or IL-23 blocker use and SARS-CoV-2 infection should thus be interpreted with caution.

The researchers concluded that additional studies are warranted to understand the effects of biologic agents on COVID-19. According to the National Psoriasis Foundation taskforce, “Biologic therapies do not meaningfully alter the risk of developing COVID-19 and should be considered in the absence of infection.”

Reference

Yan D, Kolla AM, Young T, et al. COVID-19 outcomes in patients with psoriasis and psoriatic arthritis: a prospective cohort study. JAAD Int. Published online March 28, 2022. doi:10.1016/j.jdin.2022.03.011