Psoriasis may up COVID-19 risk, effect of biologic treatment on risk varies

Patients with psoriasis may be at an increased risk of contracting COVID-19, according to a study presented at AAD VMX 2021.

Using the Symphony database, the authors identified 167,027 adults (age ≥20 years; mean age 58.1 years, 53.5 percent female, 79.1 percent Caucasian) with ≥2 ICD*-10 codes for psoriasis or psoriatic arthritis between May 1, 2019 and January 1, 2020. They were compared with a general population cohort of 1,002,162 individuals (controls; mean age 57.7 years, 55.7 percent female, 74.7 percent Caucasian). Follow-up continued until November 11, 2020.

Certain COVID-19 risk factors were more common among psoriasis patients compared with the general population. These included congestive heart failure (CHF; 6.2 percent vs 4.8 percent), type 2 diabetes (T2D; 22.7 percent vs 15.9 percent), obesity (26.7 percent vs 14.5 percent), and chronic obstructive pulmonary disease (COPD; 9.9 percent vs 6.4 percent). [AAD VMX 2021, Late-breaking Abstracts]

Patients with psoriasis were categorized based on treatment. Patients with psoriasis who were not being treated (never diagnosed with moderate-to-severe disease) comprised the topical cohort (n=99,395), those on any type of biologic treatment made up the biologic cohort (n=36,164), and biologic-naïve patients who were receiving other oral treatments (ie, acitretin, cyclosporine, methotrexate, apremilast) were the oral cohort (n=31,468). 

Of the patients with moderate-to-severe psoriasis (n=67,632), methotrexate and apremilast were the most common oral systemic treatments (32.1 and 11.1 percent, respectively). The most common biologic therapies were adalimumab (14.1 percent), secukinumab (9.3 percent), and ustekinumab (7.5 percent).

After adjusting for age and sex, the incidence of COVID-19 was significantly higher among patients with psoriasis compared with the non-psoriasis population (adjusted incidence rate ratio [adjIRR], 1.33, 95 percent confidence interval [CI], 1.23–1.38; p<0.0001).

Patients receiving tumour necrosis factor alpha (TNF-α) inhibitors had an 18 percent lower incidence of COVID-19 than those in the topical cohort (adjIRR, 0.82, 95 percent CI, 0.69–0.95; p<0.0029). However, they had a 17 percent increased incidence of COVID-19 compared with those without psoriasis (adjIRR, 1.17, 95 percent CI, 1.03–1.32; p<0.0127). 

Patients on ustekinumab had a 37 percent increased incidence of COVID-19 compared with individuals without psoriasis (adjIRR, 1.37, 95 percent CI, 1.07–1.70; p<0.0041), and a 25 percent numerically, but not significantly, increased incidence of COVID-19 compared with those on other oral treatments (adjIRR, 1.25; p<0.0604).

The use of IL-17 inhibitors was associated with increased incidence of COVID-19 compared with other oral agents (adjIRR, 1.36, 95 percent CI, 1.13–1.63; p<0.0009) or vs individuals without psoriasis (adjIRR, 1.51, 95 percent CI, 1.06–1.76; p<0.0001).

Patients on methotrexate or apremilast had a reduced incidence of COVID-19 compared with the topical group (adjIRR, 0.75, 95 percent CI, 0.67–0.86; p<0.0001 and adjIRR, 0.69, 95 percent CI, 0.55–0.85; p<0.0006, respectively).

In the demographic- and comorbidity-adjusted analysis, the risk of incident COVID-19 infection was increased among patients with psoriasis vs controls (adjusted odds ratio [adjOR], 1.182; p<0.0001).

Factors associated with an increased risk of COVID-19 among patients and controls were CHF (adjOR, 2.087), T2D (adjOR, 1.722), obesity (adjOR, 1.588), and COPD (adjOR,1.519; p<0.0001 for all).

Compared with the topical group, the risk of incident COVID-19 was lower among patients on TNF-α inhibitors (adjOR, 0.874; p<0.0469), methotrexate (adjOR, 0.808; p<0.0011), and apremilast (adjOR, 0.702; p<0.0014).

“Overall, patients with psoriasis are more likely to have an incident COVID-19 infection compared to the general population,” said study author Jeffrey Liu, a medical student at the Keck School of Medicine, University of Southern California, Los Angeles, California, US.

“Psoriasis patients commonly use systemic therapies that may increase risk of upper respiratory tract infection,” he continued.

“The impact of [the various] therapies on patient outcomes will be a pertinent topic for further COVID-19 research,” he said.