Published: October 16, 2020
The severity of COVID-19 infection varies widely between individuals, and is determined to some extent by age, ethnicity and the presence of underlying health conditions. What we do not know is how psoriasis and the medications that are used to treat it might influence the severity of COVID-19 infection. To try and answer this important question, healthcare professionals from around the world were invited to provide information about the clinical course and outcome of their patients with psoriasis who developed COVID-19 infection. Anonymised information was collected through a series of structured questions via PsoProtect, a global web-based registry.
Mahil and colleagues report the findings from the PsoProtect registry in a research article recently published in The Journal of Allergy and Clinical Immunology (JACI). Three hundred and seventy-four patients with psoriasis and COVID-19, from 25 countries, were reported to PsoProtect between March and July 2020 (median age 50 years; more men [227, 61%] than women [147, 39%]). Most of the patients (334, 89%) were taking treatments for their psoriasis that affect the immune system – either injection treatments known as ‘biologics’ that target specific immune proteins (267 patients, 71%) or traditional immunosuppressants such as methotrexate and ciclosporin (67, 18%). The dominance of people taking biologics or traditional immunosuppressants for psoriasis in the dataset likely reflects the fact that most of the reporting health care professionals were working in specialist dermatology departments.
Of those patients reported to the PsoProtect registry, the majority (348, 93%) fully recovered from COVID-19. Hospitalization was used to indicate the severity of COVID-19 infection: twenty one percent (77 patients) were admitted to hospital for COVID-19 and 9 patients (2%) died, all of whom had at least one underlying health condition. Patients who were older, male, of non-white ethnicity and with other health conditions such as chronic lung disease were more likely to require hospital admission for their COVID-19 infection. This finding has also been described in the general population, so appears to not be specific to psoriasis.
Patients taking biologics for psoriasis were less frequently hospitalized for COVID-19 compared to those receiving traditional immunosuppressants. However, we do not know that this observed association is causal. There may be other unmeasured factors that are associated with taking a biologic drug (for example very careful social distancing or shielding) that are actually causing this observation. The authors also caution that selection bias may influence the findings i.e., the population of patients reported by health care professionals to the PsoProtect registry may not be representative of the whole population of people with psoriasis who are taking drugs that affect the immune system. Further research is therefore required, and we cannot conclude that biologics are safer than traditional immunosuppressants in the context of COVID-19. Nevertheless, the current findings from the global PsoProtect registry on overall outcome from COVID-19 in patients with psoriasis taking drugs that affect the immune system remain reassuring.
The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.