Background

The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited.

Objective

Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization.

Methods

Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors.

Results

Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite ethnicity (OR = 3.15; 95% CI = 1.24-8.03), and comorbid chronic lung disease (OR = 3.87; 95% CI = 1.52-9.83). Hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94).

Conclusion

In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19–related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates.

中文翻译：

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与银屑病患者 COVID-19 不良结局相关的因素——来自一项全球注册研究的见解

背景

银屑病患者的多病负担和全身免疫抑制剂的使用可能会增加 2019 年冠状病毒病 (COVID-19) 不良后果的风险，但数据有限。

客观的

我们的目的是描述银屑病患者 COVID-19 病程的特征，并确定与住院治疗相关的因素。

方法

临床医生通过国际登记处报告确诊/疑似 COVID-19 的银屑病患者，即 COVID-19 感染的结果、治疗和流行病学银屑病患者登记处。多元逻辑回归用于评估临床和/或人口统计学特征与住院之间的关联。一个单独的面向患者的登记处以降低风险的行为为特征。

结果

在来自 25 个国家/地区的 374 名临床医生报告的患者中，71% 正在接受生物制剂治疗，18% 正在接受非生物制剂治疗，10% 未接受任何系统性银屑病治疗。总共有 348 名患者 (93%) 从 COVID-19 中完全康复，77 名 (21%) 住院，9 名 (2%) 死亡。住院风险增加与年龄较大（多变量调整比值比 [OR] = 1.59 每 10 年；95% CI = 1.19-2.13）、男性（OR = 2.51；95% CI = 1.23-5.12）、非白人种族相关(OR = 3.15；95% CI = 1.24-8.03)，并存慢性肺病 (OR = 3.87；95% CI = 1.52-9.83)。使用非生物制剂全身治疗的患者住院率高于使用生物制剂的患者（OR = 2.84；95% CI = 1.31-6.18）。生物制品类别之间未发现显着差异。

结论

在这个针对中度至重度银屑病患者的国际病例系列中，与使用非生物系统治疗相比，使用生物制剂与 COVID-19 相关住院风险较低有关；然而，由于潜在的选择偏倚和未测量的混杂因素，需要进一步调查。已确定的风险因素（年龄较大、男性、非白人和合并症）与较高的住院率相关。