Characteristic of chronic plaque psoriasis patients treated with biologics in Italy during the COVID-19 Pandemic: Risk analysis from the PSO-BIO-COVID observational study

Abstract

Background The susceptibility of patients with chronic plaque psoriasis and the risks or benefits related to the use of biological therapies for COVID-19 are unknown. Few data about prevalence, clinical course and outcomes of COVID-19 among psoriatic patients were reported. The aims of this study were 1) to assess the prevalence and severity of COVID-19 in psoriatic patients treated with biologic agents during the first phase of the emergency (22 February to 22 April 2020) in Italy, and 2) to report the clinical outcomes of patients who have been exposed to individuals with confirmed SARS-CoV-2 infection. Methods Patients with moderate-to-severe chronic plaque psoriasis, aged ≥18 years and undergoing treatment with biologic agents as of 22 February 2020, were eligible to be included in PSO-BIO-COVID study. Demographic and clinical characteristics of patients using any biologic for psoriasis treatment between 22 February and 22 April 2020 were registered. For all confirmed or suspected cases of COVID-19, data about concomitant disease, ongoing therapies, and comorbidities were also reported. Results A total of 12,807 psoriatic patients were included in the PSO-BIO-COVID study. In this cohort twenty-six patients (0.2%) had a swab confirmation of SARS-CoV-2 infection. Eleven patients required hospitalization and two died. 125 of 12807 patients (1.0%) with exposure to a patient with COVID-19 under quarantine or active health surveillance, were reported. Conclusion The incidence of COVID-19 observed in our cohort of psoriatic patients (0.2%) is similar to that seen in the general population (0.31%) in Italy. However, the course of the disease was mild in most patients. Biological therapies may likely lessen "cytokine storm" of COVID-19, which sometimes lead to multiple organ failure, ARDS, and death.

National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: Version 2—Advances in psoriatic disease management, COVID-19 vaccines, and COVID-19 treatments

“…11 In a study of 12,807 patients with psoriasis on biologics from 33 Italian dermatology centers, 26 (0.25%) had confirmed SARS-COV-2 infection (similar to general population in Italy [0.31%]). 21 In a study of patients with psoriasis (100 on topical treatment, 80 on biologics) from a single Italian dermatology center, COVID-19 symptoms were more common, but not statistically significant, in the biologic group (OR, 1.22; 95% CI, 0.58-2.58). 22 A cohort of 2329 patients with psoriasis on systemic therapy in Spain yielded standardized incidence ratios of 1.58 (95% CI, 0.98-2.41), 1.55 (95% CI, 0.67-3.06), and 1.38 (95% CI, 0.03-7.66) for COVID-19 cases, hospitalizations, and deaths, respectively.…”

“…[4][5][6][7][8] Nevertheless, patients with psoriatic disease appear to have similar rates of infection with SARS-CoV-2 and COVID-19 outcomes as the general population, with multiple new studies from Italy, which primarily focused on patients with psoriasis receiving oral or biologic treatment, supporting our initial recommendation (guidance 1.1). [9][10][11] Additional new studies of patients with psoriatic arthritis (PsA) nested within cohorts of patients with rheumatic disease also suggest that they have similar rates of infection with SARS-CoV-2 and COVID-19 outcomes as the general population. [12][13][14] However, the risk of COVID-19 in autoimmune diseases was higher than in control patients (odds ratio [OR], 2.19; 95% confidence interval [CI], 1.05-4.58) in a meta-analysis of 7 case-control studies.…”

The Effect of SARS-CoV-2 Virus Infection on the Course of Atopic Dermatitis in Patients

“…The broad spectrum of the clinical picture observed in the course of COVID-19 is largely associated with comorbidities and conditions modifying immunity, which may worsen the course of infection [14]. Data on the influence of immunosuppressants, including those used in AD, on the course of SARS-CoV-2 infection are not clear [15][16][17]. The use of glucocorticoids may predispose patients to a more severe course of COVID-19 [15,18,19].…”

The course of COVID‐19 infection and prolonged sneezing and nasal congestion in a patient using ixekizumab

“…Cohort studies and case reports report that biological treatments in patients with psoriasis do not increase the risk of COVID-19 and do not worsen the course of COVID-19. 1,2 Based on these finding, we continued the treatment of the patient.…”

“…1 In a recent study of the Italian psoriasis-biologics-COVID working group, the researchers thought that biological therapies could reduce the cytokine storm which may lead to multiorgan failure, ARDS, and death. 2…”