Prevalence, risk and severity of SARS-CoV-2 infections in psoriasis patients receiving conventional systemic, biologic or topical treatment during the COVID-19 pandemic: a cross-sectional cohort study (PsoCOVID)

Abstract

Background

The risk of SARS-CoV-2 infection does not appear to be increased for psoriasis patients using biologics compared to those on other treatments, but evidence is still limited.

Objectives

(1) to estimate the prevalence of SARS-CoV-2 infection in patients with psoriasis, (2) to compare SARS-CoV-2 infection rates for different psoriasis treatments groups (biologic vs. systemic conventional vs. topical therapy) corrected for confounders and (3) to describe patients with severe COVID-19 for all treatment groups.

Methods

In this cross-sectional cohort study all patients received a questionnaire to gather data on psoriasis treatment, SARS-CoV-2 infections and related risk factors. Simultaneously, they underwent a blood test to screen for antibodies to SARS-CoV-2 N-antigen. Prevalence of SARS-CoV-2 infections was calculated and logistic regression and Cox proportional-hazards models were performed to determine the association between treatment group and SARS-CoV-2 infection risk, corrected for confounders. Patients with severe COVID-19 disease were described and the mortality rate per treatment group was calculated for the target population.

Results

Patients were included between April 12 2021 and October 31 2021. Of 551 patients, 59 (10.7% (CI95% 8.3–13.6)) had experienced a SARS-CoV-2 infection, based on questionnaire data combined with serological data. In our study cohort, corrected for confounders, biologic or non-biologic systemic therapy users did not appear to have increased SARS-CoV-2 infection risk compared to patients using other treatment. Only 4 hospitalizations (0.7% (CI95% 0.2–1.0) were reported in our study population and no ICU admissions were reported. The rough mortality rate in the target cohort was 0.32% (CI95% 0.13–0.66) in all treatment groups.

Conclusions

Corrected for risk-mitigating behavior and vaccination status, a higher SARS-CoV-2 incidence for biologics or non-biologics systemics compared to other treatments could not be proven. Severe cases were infrequent in all treatment groups. This finding further strengthens treatment recommendations that systemic therapies for patients with psoriasis do not require preventive cessation for reduction of SARS-CoV-2 infection risk.

Keywords:

• SARS-CoV-2
• covid-19
• psoriasis
• biologics
• vaccines
• immunosuppression

Acknowledgements

The authors thank the participants, investigators, and study staff who made this study possible. We are very grateful for the statistical input of Hans MM Groenewoud and Scott Maurits of the Radboud University.

Disclosure statement

fK.V. Kwee has received a speaking fee from Eli Lilly and has carried out clinical trials for AbbVie, Novartis, Leo Pharma, Eli Lilly and Cellgene. All funding is not personal, but goes to the independent research fund of the department of dermatology of Bravis Hospital, Bergen op Zoom, the Netherlands

J.L. Murk has received speaker fees for educational events organized by Biogen and acted as consultant for Pfizer and Johnson & Johnson.

Q. Yin has carried out clinical trials for AbbVie, Novartis, Leo Pharma and Eli Lilly. All funding is not personal, but goes to the independent research fund of the department of dermatology of Bravis hospital, Bergen op Zoom, the Netherlands

E.M.G.J. de Jong has received research grants for the independent research fund of the department of dermatology of the Radboud university medical center Nijmegen, the Netherlands from AbbVie, BMS, Janssen Pharmaceutica, Leo Pharma, Novartis, and UCB for research on psoriasis and has acted as consultant and/or paid speaker for and/or participated in research sponsored by companies that manufacture drugs used for the treatment of psoriasis or eczema including AbbVie, Amgen, Almirall, Celgene, Galapagos, Janssen Pharmaceutica, Lilly, Novartis, Leo Pharma, Sanofi and UCB. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboud University medical center Nijmegen, the Netherlands.

J M.P.A. van den Reek carried out clinical trials for AbbVie, Celgene and Janssen and has received speaking fees/attended advisory boards from AbbVie, Janssen, BMS, Almirall, LEO Pharma, Novartis, UCB and Eli Lilly and reimbursement for attending a symposium from Janssen, Pfizer, Celgene and AbbVie. All funding is not personal but goes to the independent research fund of the department of dermatology of Radboudumc Nijmegen, the Netherlands.

M Tjioe has carried out clinical trials for Abbvie, Novartis, Eli Lilly, Leo Pharma, Cellgene. All trial funding is not personal but goes to the independent research fund of the department of dermatology of Bravis Hospital Bergen op Zoom, the Netherlands.

He has received speaking fees/attended advisory boards from Novartis, UCB and Pfizer and reimbursement for attending a symposium from UCB.

The other authors declare no conflicts of interests.

IRB approval status: Reviewed and approved by CMO Regio Arnhem-Nijmegen NL76575.091.21

Additional information

Funding

The PsoCovid study was funded by Novartis. Novartis had no role in the design/conduct of the study nor the interpretation of the data.