Psoriasis patients may have a higher risk of contracting COVID-19, according to study results recently presented at AAD VMX 2021.
Psoriasis affects about 2% of the adult population. Systemic therapies for moderate to severe psoriasis have been linked to an increased risk of upper respiratory viral tract infection. It is undetermined if having psoriasis itself, having comorbidities associated with psoriasis, or systematic treatments for psoriasis explain this correlation.
Jeffery Liu, BS, medical student at the Keck School of Medicine, University of California, Los Angeles, California, presented data on the association between systemic treatments and COVID-19 infection risk in patients with psoriasis at the American Academy of Dermatology Virtual Meeting Experience 2021 (AAD VMX 2021).1
The study’s objectives were to assess the risk of COVID-19 infection in adult patients with psoriasis versus the general population and assess risk of infection in patients treated with systemic therapies compared to those treated with topical therapies within the Symphony database.
The Symphony dataset is a repository of patient-level integrated data, covering 92% of retail pharmacy claims and containing more than 280 million patients, 1.8 million prescribers, and 16,00 health plans.
To be included in the study, patients needed to be 20 years or older, have International Statistical Classification of Diseases and Related Health Problems (ICD) 10 codes of 2 or more between May 1, 2019 and January 1, 2020 and had allowed concomitant therapy. The general population controls were selected in a 1:6 ratio.
The primary outcome was the incidence of COVID-19 infection codes consistent with diagnosis follow-up. Patients were split into 3 cohorts. Topical, defined as patients who had no treatments consistent to having moderate to severe disease; biologic, those who received any biologic treatment regardless of use combined with any oral agent; and oral, biologic naïve patients that received any oral agent. Controls were summarized by frequency for categorical variables and mean for continuous variables.
Poisson regression was used to examine the incident rates (IRs). Age and sex adjusted IRs were compared between the 3 cohorts and controls with adjusted incidence rate ratios (aIRRs). Multivariable logistic regression was used to examine the associated between psoriasis and COVID infection with adjusted odds ratios (aORs).
According to Liu, baseline characteristics showed psoriasis patients were more likely to be white and had a higher proportion of COVID-19 risk factors including congestive heart failure, type-2 diabetes mellitus, obesity, and chronic obstructive pulmonary disease (COPD). The majority of patients classified as having moderate to severe psoriasis were treated with methotrexate, adalimumab (Humira, AbbVie), apremilast (Otezla, Amgen), secukinumab (Cosentyx, Novartis) and ustekinumab (Stelara, Janssen Pharmaceuticals).
The aIRRs showed that 33% more patients with psoriasis had COVID-19 compared to controls. Tumor necrosis factor (TNF) α inhibitor correlated with a 18% reduction in COVID incidence compared to the topical cohort and 17% versus controls. Whereas methotrexate had a 25% reduction and apremilast had a 31% reduction when both compared to the topical cohort.
Interleukin (IL)-17 inhibitor use was associated with a 36% increase in COVID incidence versus 51% in the oral cohort and controls. For ustekinumab, there was a 37% increase versus controls and, according to Liu, a non-significant 25% compared to the oral cohort.
Using the aOR, psoriasis patients were 18% more likely to have a COVID infection. When looking at younger individuals, non-Caucasian ethnicity and comorbidities were strongly associated with a greater risk of being diagnosed with COVID in both patients and control groups.
TNF-α inhibitor users were 13% less likely to have COVID compared to patients on topical therapy. Also, apremilast and methotrexate both were less likely, 30% and 19% respectively, to have infection compared to topical therapy.
In conclusion, patients with psoriasis are more likely to have an incident COVID-19 infection compared to the general population.
For biologic treatments, TNF-α inhibitor use may be associated with lower odds of contacting the virus and according to aORs, ustekinumab and IL-17 inhibitors may be associated with higher odds.
For oral systemics, methotrexate and apremilast use may be correlated with lower odds of contracting the virus.
“The impact of these therapies on patient outcomes will be a pertinent topic of further COVID-19 research,” Liu concluded.
Jeffrey Liu has no conflicts of interests to disclose.
1. J. Liu. Association between Biologic Therapy and COVID-19 Infection Risk in Patients with Psoriasis. Presented at the: American Academy of Dermatology Virtual Meeting Experience 2021 (AAD VMX); Virtual.