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

Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect), Pedro M Machado, Martin Schäfer, Satveer K Mahil, Jean Liew, Laure Gossec, Nick Dand, Alexander Pfeil, Anja Strangfeld, Anne Constanze Regierer, Bruno Fautrel, Carla Gimena Alonso, Carla G S Saad, Christopher E M Griffiths, Claudia Lomater, Corinne Miceli-Richard, Daniel Wendling, Deshire Alpizar Rodriguez, Dieter Wiek, Elsa F MateusEmily Sirotich, Enrique R Soriano, Francinne Machado Ribeiro, Felipe Omura, Frederico Rajão Martins, Helena Santos, Jonathan Dau, Jonathan N Barker, Jonathan Hausmann, Kimme L Hyrich, Lianne Gensler, Ligia Silva, Lindsay Jacobsohn, Loreto Carmona, Marcelo M Pinheiro, Marcos David Zelaya, María de Los Ángeles Severina, Mark Yates, Maureen Dubreuil, Monique Gore-Massy, Nicoletta Romeo, Nigil Haroon, Paul Sufka, Rebecca Grainger, Rebecca Hasseli, Saskia Lawson-Tovey, Suleman Bhana, Thao Pham, Tor Olofsson, Wilson Bautista-Molano, Zenas Z N Yiu

Research output: Contribution to journalArticlepeer-review

Abstract

OBJECTIVES: To investigate factors associated with severe COVID-19 in people with psoriasis (PsO), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA).

METHODS: Demographic 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.

RESULTS: Of 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.

CONCLUSION: Older 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.

Original languageEnglish
JournalAnnals of the rheumatic diseases
Early online date14 Feb 2023
DOIs
Publication statusE-pub ahead of print - 14 Feb 2023

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