Assessing the Risk and Outcome of COVID-19 in Patients with Psoriasis or Psoriatic Arthritis on Biologic Treatment: A Critical Appraisal of the Quality of the Published Evidence

Piaserico, Stefano; Gisondi, Paolo; Cazzaniga, Simone; Leo, Sara; Naldi, Luigi

doi:10.1016/j.jid.2021.04.036

Cited by 9 publications

(12 citation statements)

References 39 publications

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“…discussed this issue of the so‐called floating numerators, which is the lack of reference to the underlying at risk population. 17 , 18 However international data concerning the prevalence of children under each systemic drug are lacking in hospital setting and private practice, not allowing to compare these proportions. Furthermore, we can also assume that asymptomatic forms of COVID‐19 were less likely to be reported by the investigators.…”

Section: Discussionmentioning

confidence: 99%

Children with psoriasis and COVID‐19: factors associated with an unfavourable COVID‐19 course, and the impact of infection on disease progression (Chi‐PsoCov registry)

Zitouni

Bursztejn

Fortina

et al. 2022

Acad Dermatol Venereol

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Background The COVID‐19 pandemic has raised questions regarding the management of chronic skin diseases, especially in patients on systemic treatments. Data concerning the use of biologics in adults with psoriasis are reassuring, but data specific to children are missing. Moreover, COVID‐19 could impact the course of psoriasis in children. Objectives The aim of this study was therefore to assess the impact of COVID‐19 on the psoriasis of children, and the severity of the infection in relation to systemic treatments. Methods We set up an international registry of paediatric psoriasis patients. Children were included if they were under 18 years of age, had a history of psoriasis, or developed it within 1 month of COVID‐19 and had COVID‐19 with or without symptoms. Results One hundred and twenty episodes of COVID‐19 in 117 children (mean age: 12.4 years) were reported. The main clinical form of psoriasis was plaque type (69.4%). Most children were without systemic treatment (54.2%); 33 (28.3%) were on biologic therapies, and 24 (20%) on non‐biologic systemic drugs. COVID‐19 was confirmed in 106 children (88.3%) and 3 children had two COVID‐19 infections each. COVID‐19 was symptomatic for 75 children (62.5%) with a mean duration of 6.5 days, significantly longer for children on non‐biologic systemic treatments ( P = 0.02) and without systemic treatment ( P = 0.006) when compared with children on biologics. The six children who required hospitalization were more frequently under non‐biologic systemic treatment when compared with the other children ( P = 0.01), and particularly under methotrexate ( P = 0.03). After COVID‐19, the psoriasis worsened in 17 cases (15.2%). Nine children (8%) developed a psoriasis in the month following COVID‐19, mainly a guttate form ( P = 0.01). Discussion Biologics appear to be safe with no increased risk of severe form of COVID‐19 in children with psoriasis. COVID‐19 was responsible for the development of psoriasis or the worsening of a known psoriasis for some children.

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Section: Discussionmentioning

confidence: 99%

Children with psoriasis and COVID‐19: factors associated with an unfavourable COVID‐19 course, and the impact of infection on disease progression (Chi‐PsoCov registry)

Zitouni

Bursztejn

Fortina

et al. 2022

Acad Dermatol Venereol

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“…A recently published study also raised some concerns about high rate of biases (e.g participation and ascertainment bias) occurring in the studies being published about this topic[29]. This was also noted in a recent systematic literature review performed to inform respective EULAR recommendations[3].…”

Section: Discussionmentioning

confidence: 99%

Different Covid-19 Outcomes Among Systemic Rheumatic Diseases: A Nation-wide Cohort Study

Bournia

Fragoulis

Mitrou

et al. 2022

Preprint

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Background: Nationwide data at a country level on Covid-19 in unvaccinated patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are scarce. Methods: By interlinking data from national electronic registries, covering nearly 99% of the Greek population (approximately 11,000,000), between March 2020 and February 2021, when vaccination became available, we recorded confirmed infections and Covid-19-associated hospitalizations and deaths in essentially all adult patients with RA, AS, PsA, SLE, and SSc under treatment (n=74,970, median age of 67.5, 51.2, 58.1, 56.2, 62.2 years, respectively) and in individually matched (1:5) on age, sex, and region of domicile random comparators from the general population. Results: Binary logistic regression analysis after adjusting for age, sex and biologic agents, revealed that RA, PsA, SLE and SSc, but not AS patients, had significantly higher risk of infection (by 43%, 25%, 20% and 49%, respectively), and hospitalization for Covid-19 (by 81%, 56%, 94%, and 111%, respectively), possibly due, at least in part, to increased testing and lower threshold for admission. Patients with RA and SSc had indeed higher Covid-19 associated mortality rates [OR:1.86 (95% CI 1.37 to 2.52) and OR:2.90 (95% CI 0.97 to 8.67), respectively] compared to the general population. Each additional year of age increased the risk of hospitalization for Covid-19 by 3% (OR 1.030, 95% CI: 1.028 to 1.034) and the risk of Covid-19 related death by 8% (OR 1.08, 95% CI: 1.07 to 1.09), independently of gender, systemic rheumatic disease, and biologic agents. A further analysis using AS patients as the reference category, adjusting again for age, sex and use of biologic agents showed that patients with SSc had increased mortality (OR: 6.90, 95% CI: 1.41 to 33.72), followed by SLE (OR: 4.05 95% CI: 0.96 to 17.12) and RA patients (OR: 3.65, 95% CI: 1.06 to 12.54), whereas PsA patients had comparable mortality risk with AS patients. Conclusion: Comparing to the general population, Covid-19 may have a more severe impact in real-world patients with systemic rheumatic disease. Covid-19 related mortality is increased in subgroups of patients with specific rheumatic diseases, especially in older ones, underscoring the need for priority vaccination policies and access to targeted treatments.

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“…In the early days of the pandemic, it was highlighted that well-designed studies were needed to assess whether the risk for adverse COVID-19-related outcomes was increased for SRD patients [ 1 ]. Currently, more than 2 years after the start of the pandemic, several studies assessing the impact of COVID-19 on SRD patients have been published, but only a handful of them are of high-quality and/or powered enough to address these questions [ 2 , 3 ]. Along these lines, the need for more robust data about the vulnerability of SRD patients to COVID-19 and its adverse outcomes is still stressed by experts in the field [ 4 , 5 ].…”

mentioning

confidence: 99%

Different systemic rheumatic diseases as risk factors for COVID-19-related mortality

Fragoulis¹,

Bournia²,

Sfikakis³

2022

Clin Rheumatol

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COVID-19 has been associated with increased morbidity and mortality, globally. Whether COVID-19-related mortality is increased in patients with systemic rheumatic diseases (SRDs) is still debatable. Although results are somewhat conflicting, there are a handful of nationwide studies published indicating that, in individuals with SRD, there is signal for increased adverse COVID-19-related outcomes and higher mortality. It appears that there are differences in COVID-19-related mortality across various SRDs. Besides, certain disease-specific (disease activity, disease duration, medication received) and/or other features (e.g. comorbidities) seem to also affect COVID-19-related mortality in SRD patients. Herein, we wanted to highlight that a more individualized approach taking into consideration the effect of the aforementioned factors into the risk calculation for COVID-19 adverse outcomes, including mortality, in SRD patients is warranted. A multinational study based on nationwide data, examining all common SRDs and stratifying accordingly, would be of interest, toward this direction. Key Points • It is still debatable whether Covid-19-related mortality is increased in patients with sytemic rheumatic diseases (SRD) . • Disease-specific risk factors (e.g. type of SRD, disease activity) should be taken into account in risk assessment for Covid-19-releted outcomes in SRD patients .

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Assessing the Risk and Outcome of COVID-19 in Patients with Psoriasis or Psoriatic Arthritis on Biologic Treatment: A Critical Appraisal of the Quality of the Published Evidence

Cited by 9 publications

References 39 publications

Children with psoriasis and COVID‐19: factors associated with an unfavourable COVID‐19 course, and the impact of infection on disease progression (Chi‐PsoCov registry)

Children with psoriasis and COVID‐19: factors associated with an unfavourable COVID‐19 course, and the impact of infection on disease progression (Chi‐PsoCov registry)

Different Covid-19 Outcomes Among Systemic Rheumatic Diseases: A Nation-wide Cohort Study

Different systemic rheumatic diseases as risk factors for COVID-19-related mortality

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