key: cord-302571-vb9ks4mq
authors: Damiani, Giovanni; Pacifico, Alessia; Bragazzi, Nicola L.; Malagoli, Piergiorgio
title: Biologics increase the risk of SARS‐CoV‐2 infection and hospitalization, but not ICU admission and death: Real‐life data from a large cohort during red‐zone declaration
date: 2020-05-19
journal: Dermatol Ther
DOI: 10.1111/dth.13475
sha: 
doc_id: 302571
cord_uid: vb9ks4mq

During COVID‐19 outbreak there are discordant opinions toward the impact on biologics in psoriatic (PsO) patients. Thus we performed a single‐center case‐control study in Lombardia, the Italian region with the higher number of COVID‐19 confirmed cases. We enrolled 1193 PsO patients treated with biologics and small molecules and we used the entire Lombardia population as controls. Notably, 17 PsO patients COVID‐19 confirmed were quarantined at home and five hospitalized, no PsO patients were admitted to intensive care unit (ICU) or died. With respect to the general population of Lombardy, patients on biologics were at higher risk to test positive for COVID‐19 (odds ratio [OR] 3.43 [95% confidence interval (CI) 2.25‐5.73], P < .0001), to be self‐quarantined at home (OR 9.05 [95% CI 5.61‐14.61], P < .0001) and hospitalized (OR 3.59 [95% CI 1.49‐8.63], P = .0044), however, not increased risk of ICU admission or death were found. PsO patients on biologics should be carefully monitored with telemedicine during COVID‐19 outbreak and early treated at home to limit hospital overwhelm.

Since March 8, 2020, Lombardia region experienced COVID-19 lockdown and only after 2 days the entire Italy became red-zone. Nowadays, Lombardia is the Italian region with more confirmed, hospitalized, and dead COVID-19 patients.

Despite the higher risk for COVID-19 displayed by obese, active smokers, and COPD patients, 1 almost no data are present toward psoriatic (PsO) patients and biologics.

Moderate to severe psoriasis benefit from systemic treatment as biologics and small molecules; at the same time these drugs, capable to clear psoriasis, are related also to an increased risk of airway infections. 2 PsO patients also display a baseline airway inflammation that triggers the constellation of chronic respiratory comorbidities, such as asthma and chronic obstructive pulmonary disease (COPD). 3 Furthermore, PsO patients are frequently smokers and cigarettes increased flares as well as psoriasis severity, predisposing to COPD and exacerbating asthma crisis. 4 Thus, we performed this study aiming to understand the effect of biologics in PsO patients during COVID-19 outbreak focusing on symptomatic patients quarantined at home, hospitalized, and their prognosis. 

PsO patients on biologics displayed higher risk to be infected and to be hospitalized/self-quarantined at home, but ICU hospitalization and death did not differ from the general population. Notably, PsO patients display baseline airway inflammation that clears with anti-PsO therapies, preliminary data suggest that airways inflammation is downregulated by treating skin inflammation. 8 The lung-skin inflammatory reciprocal interactions was modelized by Nadeem et al claiming that skin inflammation via IL-23/STAT3 signaling modulates airway inflammation and vice versa. 9 These findings offer also a rationale to continue biologics in PsO patients to prevent the lung-skin inflammatory axis and to inhibit the progression to the hyperinflammatory phase.

Despite this study is the first to assess the impact of biologics among PsO patients during COVID-19, it did not assess the family members, so future studies should also evaluate this aspect.

Biologics may not increase the risk of ICU hospitalization and death; however, they increase the risk of mild to moderate disease.

Thus, PsO patients on biologics should be carefully monitored with teledermatology and early treated at COVID-19 symptoms early onset.

Clinical features and short-term outcomes of 221 patients with COVID-19 in Wuhan

Safety of systemic agents for the treatment of pediatric psoriasis

Psoriasis and respiratory comorbidities: the added value of fraction of exhaled nitric oxide as a new method to detect, evaluate, and monitor psoriatic systemic involvement and therapeutic efficacy

Lifestyle changes for treating psoriasis

COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal

A subset analysis of efficacy and safety outcomes from phase 3 clinical studies of ixekizumab for the treatment of patients with severe plaque psoriasis

Why tocilizumab could be an effective treatment for severe COVID-19?

Increased airway inflammation in patients with psoriasis

Psoriatic inflammation enhances allergic airway inflammation through IL-23/STAT3 signaling in a murine model

Biologics increase the risk of SARS-CoV-2 infection and hospitalization, but not ICU admission and death: Real-life data from a large cohort during red-zone declaration

The authors declare no potential conflict of interest.

https://orcid.org/0000-0002-2390-6505Alessia Pacifico https://orcid.org/0000-0003-0348-0620