Psoriasis registries yield important data about COVID-19

Shortly after COVID-19 was declared a pandemic, the PsoProtect registry was set up. The patient counterpart PsoProtectMe was launched at the beginning of May. These registries yielded interesting data to inform guidelines.

“These efforts were initiated to address unmet needs in the pandemic,” Dr Satveer Mahil (St John’s Institute of Dermatology, UK) explained [1]. Psoriasis is a common, lifelong immune-mediated condition associated with long-term health conditions, including obesity and mental health issues.

Early in the pandemic several risk factors were shown to be associated with COVID-19-related death, such as chronic liver disease and obesity [2]. “These factors are relevant to our patients with psoriasis,” said Dr Mahil. Moreover, the pathogenesis of psoriasis and COVID-19 show overlapping immune pathways [3]. Finally, psoriasis treatment affects the immune system.

Thus, it was hypothesised that in the early stage of a SARS-CoV-2 infection agents used to treat psoriasis may suppress a protective antiviral immune response. At a later stage, some patients developed an overwhelming hyperimmune response, the hyperinflammatory phase [4]. “Could it be that these drugs are protective in this later phase?”

In search of answers, 2 registries were set up with the following aims:

• PsoProtect (psoprotect.org): to characterise the course of COVID-19 in people with psoriasis and identify factors associated with severe COVID-19; and
• PsoProtectMe (psoprotectme.org): to understand experiences of people with psoriasis in the pandemic.

PsoProtect is an international registry for clinicians to report outcomes of COVID-19 in individuals with psoriasis. Outcomes can be reported through a simple case report form. PsoProtectMe is a companion global registry for people with psoriasis to self-report their experiences during the pandemic, irrespective of whether they have had COVID-19. PsoProtectMe contains optional additional questions about COVID-19 risk-mitigating behaviour such as shielding and validated screening tools evaluating depression and anxiety. The website is a global and collaborative effort.

Currently, over 1,100 clinician-reported cases of COVID-19 in patients with psoriasis are registered in PsoProtect, mainly from Europe. Approximately 4,500 people with psoriasis have completed the PsoProtectMe survey. Many countries from Europe to South America are well represented.

The first paper evaluating data from PsoProtect demonstrated that most patients with clinician-reported COVID-19 were receiving drugs that affect the immune system (71% biologics and 18% non-biologics) [5]. “In this cohort of patients treated with immunosuppressive agents, >90% fully recovered from COVID-19. In addition, risk factors for hospitalisation for COVID-19 in people with psoriasis were similar to risk factors in the general population,” Dr Mahil elaborated. Patients on non-biologic immunosuppressants had an increased risk of hospitalisation for COVID-19 compared with those taking biologics (OR 2.84). This finding was also observed in other registries, particularly in a rheumatology registry and in SECURE-IBD” [6].

In a joint study by PsoProtect and the CORE-UK study groups, Dr Mahil and colleagues found that patients with inflammatory skin and joint diseases receiving biologics were performing more stringent risk-mitigating behaviour during the COVID-19 pandemic compared with those receiving standard systemic or no systemic therapy (shielding in 66%, 59%, and 59%, respectively) [7]. The greater risk-mitigating behaviour among those receiving biologics may contribute to the reported lower risk of adverse COVID-19 outcomes in this group.

In a separate analysis of this registry, Dr Mahil and others showed that a self-reported worsening of psoriasis in the COVID-19 pandemic was associated with anxiety and depression [8]. Furthermore, 19% of participants delayed or stopped their tablet or injection treatment for psoriasis during the pandemic. Delaying/stopping treatment was associated with worsening psoriasis (OR 2.9). The most common reason for delaying/stopping was concern regarding complications related to COVID-19. Anxiety and depression were more prevalent in those who delayed/stopped medication compared with those who continued their psoriasis treatment (42.8% vs 32.4%). These outcomes contributed to the development of a statement on COVID-19 and psoriasis by the IPC [9]. This was reflected into the National Psoriasis Foundation COVID-19 Task force Guidance for the management of psoriatic disease during the pandemic [10].

1. Mahil S. Psoriasis and COVID-19 – Findings from PsoProtectMe. 6^th World Psoriasis & Psoriatic Arthritis Conference, 30 June–3 July 2021.
2. Williamson EJ, et al. Nature. 2020;584:430–6.
3. Schett G, et al. Nat Rev Immunol. 2020;20:271–2.
4. Siddiqi HK, Mehra MR. J Heart Lung Transplant. 2020;39:405–7.
5. Mahil SK, et al. J Allergy Clin Immunol. 2021;147:60–71.
6. Akiyama S, et al. Ann Rheum Dis. 2020 Oct 13:annrheumdis-2020-218946.
7. Mahil SK, et al. Br J Dermatol. 2021;185:80–90.
8. Mahil SK, et al. J Eur Acad Dermatol Venereol. 2021 Jun 17. Doi: 10.1111/jdv.17450.
9. IPC Statement on COVID-19 and Psoriasis, 1 September 2020. psoriasiscouncil.org/blog/COVID-19-Statement.htm
10. Gelfand JM, et al. J Am Acad Dermatol. 2021;84:1254–68.

 

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Posted on 17 September 202120 September 2021