Risk mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey

S K Mahil, M Yates, S M Langan, Z Z N Yiu, T Tsakok, N Dand, K J Mason, H McAteer, F Meynell, B Coker, A Vincent, D Urmston, A Vesty, J Kelly, C Lancelot, L Moorhead, H Bachelez, I N Bruce, F Capon, C R ContrerasA P Cope, C De La Cruz, P Di Meglio, P Gisondi, K Hyrich, D Jullien, J Lambert, H Marzo-Ortega, I McKinnes, L Naldi, S Norton, L Puig, R Sengupta, P Spuls, T Torres, R B Warren, H Waweru, J Weinman, C M Griffiths, J N Barker, M A Brown, J B Galloway, C H Smith

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OBJECTIVES: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation.

METHODS: Online surveys were completed by individuals with psoriasis (globally) or Rheumatic and Musculoskeletal Diseases (RMD) (UK only) between 4th May and 7th September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterised international variation in a mixed effects model.

RESULTS: Of 3,720 participants (2,869 psoriasis, 851 RMD) from 74 countries, 2,262 (60.8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and JAK inhibitors) reported shielding compared to those receiving no systemic therapy (adjusted odds ratio [OR] 1.63, 95% CI 1.35-1.97) and standard systemic agents (OR 1.39, 95% CI 1.22-1.56). Shielding was associated with established risk factors for severe COVID-19 (male sex [OR 1.14, 95% CI 1.05-1.24], obesity [OR 1.38, 95% CI 1.23-1.54], comorbidity burden [OR 1.43, 95% CI 1.15-1.78]), a primary indication of RMD (OR 1.37, 95% CI 1.27-1.48) and a positive anxiety or depression screen (OR 1.57, 95% CI 1.36-1.80). Modest differences in the proportion shielding were observed across nations.

CONCLUSIONS: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk mitigation strategies and may help inform updated public health guidelines as the pandemic continues.

Original languageEnglish
JournalThe British journal of dermatology
Early online date23 Dec 2020
Publication statusPublished - Jan 2021


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