Biologic psoriasis treatment and COVID-19 risk: Contradictory results

SARS-CoV-2 infections confront physicians with an ongoing number of puzzles. Two studies assessing the risk of developing COVID-19 for psoriasis patients treated with biologics presented contradictory results at the EADV 2020 Virtual Congress [1,2].

Systemic and biologic psoriasis treatments have been associated with an increased risk of infection. Thus, Dr Anne-Claire Fougerousse (Military Teaching Hospital Bégin, France) and her team assessed the frequency of severe COVID-19 in psoriasis patients receiving systemic or biologic treatment during the 4 months following treatment initiation [1]. This national, multicentre, cross-sectional study included 1,418 adult psoriasis patients, who received systemic psoriasis treatment from 27 April to 7 May 2020. Besides data on the psoriasis treatment and the treatment period (initiation or maintenance), data on comorbidities such as hypertension, obesity, and diabetes was collected. Where possible, probable cases of COVID-19 were confirmed by polymerase chain reaction.

Of the participants, 23.27% were treated with conventional disease-modifying drugs, 70.87% with biologics, and the remaining patients received apremilast or a combination of methotrexate and biologics. Five patients (0.35%) had a COVID-19 disease course that required hospitalisation, 2 of them required intensive care, and no patient died. The 2 patients requiring intensive care had known risk factors for severe COVID-19; both were obese and 1 patient was 71 years old. A total of 60% of patients had other risk factors for severe COVID-19. There was no difference in the number of severe cases of COVID-19 according to the treatment period.

“Our study revealed that there is no additional risk of hospitalisation or intensive care in patients receiving systemic or biological treatment for psoriasis when compared with the general population,” concluded Dr Fougerousse.

Different results in a single-centre Italian study

A second study performed in the San Donato Hospital in Milan, Italy, compared the risk of SARS-CoV-2 infections in 1,193 psoriasis patients treated with biologics and small molecules with the general population of the Lombardy Region from 21 February until 9 April 2020 [2]. Compared with the general population, patients receiving biologics were at a higher risk of testing positive for COVID-19 (unadjusted OR 3.43; 95% CI 2.25-5.73; P<0.0001), being self-quarantined at home (OR 9.05; 95% CI 5.61-14.61; P<0.0001), and being hospitalised (unadjusted OR 3.59; 95% CI 1.49-8.63; P=0.0044). However, their risk of being admitted to intensive care (unadjusted OR 3.41; 95% CI 0.21-54.55; P=0.3861) and of dying (unadjusted OR 0.41; 95% CI 0.03-6.59; P=0.5306) was not statistically significant compared with the general population.

Thus, Dr Giovanni Damiani (University of Milan, Italy) concluded that biologics seem to be protective against a COVID-19 poor prognosis but not infection preventive. The better prognosis of patients treated with immunosuppressants may be due to immunosuppressants improving the third inflammatory phase of a COVID-19 infection characterised by a cytokine storm and hypercoagulation that is associated with severe disease and death.

 

1. 
   
   1. Fougerousse Systemic or biologic treatment in psoriasis patient does not increase the risk of a severe form of COVID-19 FC02.03, EADV 2020 Virtual Congress, 29-31 Oct.
   2. Damiani G, et al. The impact of COVID-19 in a large population of psoriatic patients undergoing biologics. FC01.07, EADV 2020 Virtual Congress, 29-31 Oct.

 



Posted on 17 December, 202018 December, 2020