Journal Article

Characteristics associated with poor COVID-19 outcomes in people with psoriasis, psoriatic arthritis and axial spondyloarthritis: data from the COVID-19 PsoProtect and Global Rheumatology Alliance physician-reported registries

Jacobsohn, Lindsay, Wallace, Zachary S, Sufka, Paul, Grainger, Rebecca, Zelaya, Marcos David, Alonso, Carla Gimena, Bautista-Molano, Wilson, Gore-Massy, Monique, Robinson, Philip C, Pfeil, Alexander, Lomater, Claudia, Dau, Jonathan, Ribeiro, Francinne Machado, Carmona, Loreto, Hasseli, Rebecca, Rajão Martins, Frederico, Santos, Helena, Regierer, Anne Constanze, Gensler, Lianne, Saad, Carla G S, Barker, Jonathan N, Bhana, Suleman, Liew, Jean, Omura, Felipe, Silva, Ligia, Yates, Mark, Soriano, Enrique R, Fautrel, Bruno, Yiu, Zenas Z N, Wendling, Daniel, Gossec, Laure, Hausmann, Jonathan, Hyrich, Kimme L, Sirotich, Emily, Dand, Nick, Alpizar Rodriguez, Deshire, Mahil, Satveer K, Romeo, Nicoletta, Dubreuil, Maureen, Griffiths, Christopher E M, Yazdany, Jinoos, Pham, Thao, Severina, María de los Ángeles, Smith, Catherine H, Olofsson, Tor, Lawson-Tovey, Saskia, Schäfer, Martin, Pinheiro, Marcelo M, Wiek, Dieter, Mateus, Elsa F, Haroon, Nigil, Machado, Pedro M, Strangfeld, Anja, Miceli-Richard, Corinne

2023

Overview

ObjectivesTo investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).MethodsDemographic data, clinical characteristics and COVID-19 outcome severity of adults with PsO, PsA and axSpA were obtained from two international physician-reported registries. A three-point ordinal COVID-19 severity scale was defined: no hospitalisation, hospitalisation (and no death) and death. ORs were estimated using multivariable ordinal logistic regression.ResultsOf 5045 cases, 18.3% had PsO, 45.5% PsA and 36.3% axSpA. Most (83.6%) were not hospitalised, 14.6% were hospitalised and 1.8% died. Older age was non-linearly associated with COVID-19 severity. Male sex (OR 1.54, 95% CI 1.30 to 1.83), cardiovascular, respiratory, renal, metabolic and cancer comorbidities (ORs 1.25–2.89), moderate/high disease activity and/or glucocorticoid use (ORs 1.39–2.23, vs remission/low disease activity and no glucocorticoids) were associated with increased odds of severe COVID-19. Later pandemic time periods (ORs 0.42–0.52, vs until 15 June 2020), PsO (OR 0.49, 95% CI 0.37 to 0.65, vs PsA) and baseline exposure to TNFi, IL17i and IL-23i/IL-12+23i (OR 0.57, 95% CI 0.44 to 0.73; OR 0.62, 95% CI 0.45 to 0.87; OR 0.67, 95% CI 0.45 to 0.98; respectively; vs no disease-modifying antirheumatic drug) were associated with reduced odds of severe COVID-19.ConclusionOlder age, male sex, comorbidity burden, higher disease activity and glucocorticoid intake were associated with more severe COVID-19. Later pandemic time periods, PsO and exposure to TNFi, IL17i and IL-23i/IL-12+23i were associated with less severe COVID-19. These findings will enable risk stratification and inform management decisions for patients with PsO, PsA and axSpA during COVID-19 waves or similar future respiratory pandemics.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited,BMJ Publishing Group
• Subject: Adult / Ankylosing / Arthritis / Arthritis, Psoriatic / Arthritis, Psoriatic - complications / Arthritis, Psoriatic - drug therapy / Arthritis, Psoriatic - epidemiology / Asymptomatic / Autoimmunity / Axial Spondyloarthritis / Biological products / Chronic obstructive pulmonary disease / Clinical Medicine / Comorbidity / Coronaviruses / COVID-19 / COVID-19 - complications / COVID-19 - epidemiology / Dermatology / Diabetes / Drugs / Epidemiology / Glucocorticoids / Hospitalization / Humans / Hypertension / Infections / Inflammatory diseases / Interleukin 12 / Klinisk medicin / Life Sciences / Male / Medical and Health Sciences / Medicin och hälsovetenskap / Missing data / Neuromuscular diseases / Pandemics / Patients / Physicians / Population / Psoriasis / Psoriasis - complications / Psoriasis - drug therapy / Psoriasis - epidemiology / Psoriatic / Psoriatic arthritis / Registries / Regression analysis / Remission / Rheumatic diseases / Rheumatology / Severe acute respiratory syndrome coronavirus 2 / Spondylitis / Spondylitis, Ankylosing