Biologic psoriasis treatment and COVID-19 risk: still a matter of debate

COVID-19 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 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 Begin, France) and her team assessed the frequency of severe COVID-19 infections in psoriasis patients receiving systemic or biologic treatment, particularly during the 4 months following treatment initiation [1]. This national, multicentre, cross-sectional study included 1,418 adult psoriasis patients receiving systemic psoriasis treatment from 27 April to 7 May 2020. Besides data on the psoriasis treatment and the treatment period (initiation or maintenance), comorbidities like hypertension, obesity, and diabetes were collected. Where possible, probable cases of COVID-19 infections 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 infection that required hospitalisation, 2 of them required intensive care, no patient died. The 2 patients requiring intensive care had known risk factors for severe COVID infections; both were obese, and 1 patient was 71 years old. A total of 60% of patients had other risk factors for severe COVID-19 infections. 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 COVID-19 infections in 1,193 psoriatic patients treated with biologics and small molecules with the population of the Lombardy Region from 21 February until 9 April [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 from 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. Abstract 3090, EADV Virtual, 29-31 October 2020.

 



Posted on 30 October 202018 December 2020