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)

Figures & data

Figure 1. Inclusion flowchart. BT: biologic therapies; ST: systemic therapies; TT: topical therapies.

Table 1. Patient and treatment characteristics of patients included in PsoCovid (n = 551).

N (%), mean ± standard deviation, median [range min-max]
Sex (male)	309	56.1%
Age at moment of study inclusion	59.0	[18–88]
Disease duration at study inclusion (years)	25.0	[0.5–67.0]
Psoriatic arthritis (yes)^a	88	16.0%
Weight (kg)	84.0	[44.0–156.0]
BMI (kg/m^2)	27.1	[16.0–48.9]
Intoxications
Smoking (yes, currently)	105	19.1%
Smoking (yes, only in past)	299	54.4%
Alcohol (yes)	360	65.5%
If yes, units/week	5.0	[0–25]
Drugs	13	2.4%
Treatment
Topical therapy (TT)	147	26.7%
Biologic immunosuppressive therapy (BT)^b	226	41.0%
Etanercept	20	8.8% (out of 226)
Adalimumab	66	29.2%
Infliximab	1	0.4%
Certolizumab-pegol	2	0.9%
Ustekinumab	71	31.4%
Secukinumab	26	11.5%
Ixekizumab	44	19.4%
Brodalumab	21	9.3%
Guselkumab	8	3.5%
Risankizumab	3	1.3%
Tildrakizumab	2	0.9%
Biologic combined with methotrexate	27	11.9%
Systemic immunosuppressive therapy (ST) without biologic^b	178	32.3%
MTX	112	62.9% (of 178)
Fumaric acid ester	70	39.3%
Ciclosporine	7	3.9%
Acitretin	2	1.1%
Apremilast	1	0.6%
Comorbidities
Chronic lung disease (yes)	47	8.5%
Chronic heart disease (yes)	47	8.5%
Diabetes Mellitus (type 1/2) (yes)	47	8.5%
Significant liver disease (yes)	4	0.7%
Significant kidney disease (yes)	1	0.2%
Transplant recipient	–	–
Haematological disease	3	0.5%
Auto-immune disease (excl. psoriasis/PsA)	38	6.9%
Severely impaired immune system or HIV/Aids	–	–
Radio- or chemotherapy for malignancy in ‘20/’21	–	–

BMI: body mass index; MTX: methotrexate.

^aPercentage based on patients with known diagnosis and patients without diagnosis; patients with unknown diagnosis were excluded. Disease duration: 4 missings; intoxications: 1 missing.

^bPatients with biologics or systemic therapies were ≥3 months exposed to compound between march 2020-end of follow up, before being considered as active users. Note that for the breakdown in specific biologics/systemics, more biologics could have been used per patient.

Table 2. Information on vaccination and infection with SARS-CoV-2 of patients included in PsoCovid – results from questionnaires (n = 551).

N, %, (95% confidence interval), mean ± standard deviation, median [range min-max]
Vaccination
Received Covid-vaccine? (yes)	425	77.1% (73.4–80.6)
Pfizer/BioNTech	300	70.6% (66.0–74.9)
Moderna	21	4.9% (3.1–7.5)
AstraZeneca/Oxford	96	22.6% (18.7–26.9)
Janssen	8	1.9% (0.9–3.7)
Fully^a vaccinated? (yes, % of total cohort)	273	49.6% (45.3–53.8)
Infection (as reported in questionnaire)
SARS-CoV-2 infection (PCR-confirmed)	52	9.4% (7.1–12.2)
Admission to hospital?	4	0.8% (0.2–1.9)
Oxygen support	3	75% (19.4–99.4) (out of 4 admissions)
Pneumonia	2	50% (6.8–93.2)
Thromboembolic complication	0	0%
Renal failure/damage	2	50% (6.8–93.2)
Other complications	0	0%
Admission intensive care unit?	0	0%
Second SARS-CoV-2 infection (PCR-confirmed)	2	0.4% (0.0–1.3)
Suspicion of infection, but not tested	95	17.6% (14.2–20.7)
Complaints (first infection):
Fever	24	46.2% (32.3–60.5) out of 52 infections
Cough	26	50.0% (35.8–61.2)
Rhinitis	17	32.7% (20.3–47.1)
Dyspnea	18	34.6% (22.0–49.1)
Loss of taste	24	46.2% (32.3–60.5)
Loss of smell	19	36.5% (23.6–51.0)
Myalgia	24	46.2% (32.3–60.5)
Laryngitis/sore throat	14	26.9% (15.6–41.0)
Diarrhea	3	5.8% (1.2–16.0)
Headache	22	42.3% (28.7–56.8)
Other	6	11.5% (4.4–23.4)
Risk-mitigating behavior
Complete Quarantine	11	2.0% (1.0–3.5)
Very strict/shielding	81	14.9% (11.6–18.0)
Stricter than national guidelines	71	13.1% (10.2–16.0)
Normal follow up of national guidelines	352	64.7% (59.7–67.9)
Less strict than national guidelines	23	4.2% (2.7–6.2)
Other	6	1.1% (0.4–2.4)

^aReceived at least 2 dosages of Pfizer/Moderna/AstraZeneca COVID-vaccine, or 1 dosage of Janssen COVID-vaccine. Vaccination: 1 missing; Full vaccination: 2 missings; Infection: 1 missing; suspicion of infection: 10 missing; risk-mitigating behavior: 7 missing.

Table 3. Interpretation blood test (n = 551 with questionnaire completed; n = 482 with serum antibody test and questionnaire completed) per treatment group.

N (%), mean ± standard deviation, median [range min-max]
Total group
PCR and N-antigen positive	24	4.4% (2.8–6.4) out of 551
PCR negative/no PCR but N-antigen positive	7	1.3% (0.5–2.6)
PCR positive but not N-antigen positive	20	3.6% (2.2–5.6)
PCR negative nor N-antigen positive	430	78% (74.4–81.4)
PCR positive, no blood sampled	8	1.5% (0.6–2.8)
PCR negative/no PCR, no blood sampled	61	11.1% (8.6–14.0)
Missing answer questionnaire, N-antigen negative	1	0.2% (0.0–1.0)
PCR confirmed only:	52	9.4% (7.1–12.2)
Biologics users (n = 226)	15	6.6% (3.8–10.7) of biologic users
Systemic therapy users (n = 178)	17	9.6% (5.7–14.9) of systemic users
Topical therapy users (n = 147)	20	13.6% (8.5–20.2) of topical users
Composite endpoint: PCR and/or N-antigen positive	59	10.7% (8.3–13.6)
Biologics users (n = 226)	19	8.4% (5.1–12.8) of biologic users
Systemic therapy users (n = 178)	19	10.7% (6.5–16.1) of systemic users
Topical therapy users (n = 147)	21	14.2% (9.1–21.0) of topical users

Table 4. SARS-CoV-2 infections and behavior split per treatment group – results of questionnaires and serum antibody tests.

N (%), mean ± standard deviation, median [range min-max]
Biologics (n = 226)
SARS-CoV-2 infection ( PCR and/or N-antigen positive)	19	8.4% (5.1–12.8)
Hospitalization due to severe SARS-CoV-2 infection	1	0.4% (0.0–2.4)
Stricter^a risk-mitigating behavior	71	32.1%^b (26.0–38.7)
Complete Quarantine	5	2.3%^b (0.7–5.2)
Very strict/shielding	38	17.2%^b (12.5–22.8)
Stricter than national guidelines but not shielding/complete quarantine	28	12.7%^b (8.6–17.8)
Systemic (n = 178)
SARS-CoV-2 infection ( PCR and/or N-antigen positive)	19	10.7% (6.6–16.2)
Hospitalization due to severe Covid-19	1	0.6% (0.0–3.1)
Stricter^a risk-mitigating behavior	50	28.1% (21.6–35.3)
Complete Quarantine	5	2.8% (0.9–6.4)
Very strict/shielding	20	11.2% (7.0–16.8)
Stricter than national guidelines but not shielding/complete quarantine	25	14.0% (9.3–20.0)
Topical (n = 147)
SARS-CoV-2 infection ( PCR and/or N-antigen positive)	21	14.2% (9.1–21.0)
Hospitalization due to severe Covid-19	2	1.4% (0.2–4.8)
Stricter^a risk-mitigating behavior	42	29.2%^c (21.9–37.3)
Complete Quarantine	1	0.7%^c (0.0–3.8)
Very strict/shielding	23	16.0%^c (10.4–23.0)
Stricter than national guidelines but not shielding/complete quarantine	18	12.5%^c (7.6–19.0)

^aStricter than national guidelines indicated.

^bdata of 5 biologic users missing on risk-mitigating behavior.

^cdata of 3 topical therapy users missing on risk-mitigating behavior.

Table 5. Logistic regression analysis: factors associated with SARS-CoV-2 infection (composite endpoint PCR and serum antibody confirmed cases).

	Univariable analysis		Multivariable analysis corrected for vaccination, risk behavior, age, sex, weight
Variable	OR [(95% confidence interval)	P-value	OR [(95% confidence interval)	p Value
Treatment group
ST vs. BT/TT	0.717 [0.369–1.392]	0.325	0.502 [0.236–1. 065]	.073
BT vs. ST/TT	0.551 [0.285–1.064]	0.076	0.382 [0.182–0.801]	.011
Age (years)	1.000 [0.980–1.021]	0.970	1.046 [1.017–1.075]	.002
Sex (male vs. female)	0.598 [0.330–1.083]	0.090	0.684 [0.351–1.332]	.264
BMI (kg/m2)	0.984 [0.929–1.042]	0.573
Weight (kg)	0.988 [0.972–1.005]	0.176	0.991 [0.971–1.012]	.412
Psoriasis duration (years)	0.993 [0.975–1.011]	0.437
Smoking (never/stopped before 2020)	1.567 [0.747–3.287]	0.235
Comorbidities (absence of)	1.118 [ 0.643–1.944]	0.693
Lung disease (absence of)	1.008 [0.382–2.657]	0.987
Diabetes mellitus type 1 or 2 (absence of)	0.803 [0.326–1.981]	0.634
Psoriatic arthritis (absence of)	1.464 [0.642–3.338]	0.365
Paid work (absence of)	0.732 [0.414–1.296]	0.284
Patient reports stricter/shielding behavior^a	1.226 [0.691–2.176]	0.485	1.105 [0.573–2132]	.765
Proportion of time with ≥1 vaccination (increasing)^b	0.723 [0.638–0.820]	<0.0001	0.683 [0.594–0.787]	<.0001
Treatment group (TT as reference group)
ST vs. TT only	0.717 [0.369–1.392]	0.325	0.510 [0.239–1.088]	.082
BT vs. TT only	0.551 [0.285–1.064]	0.076	0.362 [0.167–0.783]	.010

OR: Odds ratio.

^apatients reported to live an isolated life or stricter shielding than national guidelines.

^btime vaccinated was divided by total follow up time.