key: cord-0807524-ngjbvik6 authors: Mahil, S.K.; Yiu, Z.Z.N.; Mason, K.J.; Dand, N.; Coker, B.; Wall, D.; Fletcher, G.; Bosma, A.; Capon, F.; Iversen, L.; Langan, S.M.; Di Meglio, P.; Musters, A.; Prieto‐Merino, D.; Tsakok, T.; Warren, R.B.; Flohr, C.; Spuls, P.; Griffiths, C.E.M.; Barker, J.; Irvine, A.D; Smith, C.H. title: Global reporting of cases of COVID‐19 in psoriasis and atopic dermatitis: an opportunity to inform care during a pandemic date: 2020-04-29 journal: Br J Dermatol DOI: 10.1111/bjd.19161 sha: 0e2cda1ba312950d53365c757ce038aeef15fce8 doc_id: 807524 cord_uid: ngjbvik6 We wish to bring your attention to the PsoPROTECT (Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of Covid‐19 infecTion) and SECURE‐AD (Surveillance Epidemiology of Coronavirus Under Research Exclusion‐Atopic Dermatitis) registries; two urgent global initiatives that address an unmet need for delineating the determinants of COVID‐19 outcomes in the common cutaneous immune‐mediated inflammatory diseases (IMIDs) psoriasis and atopic dermatitis. This article is protected by copyright. All rights reserved To the Editor, We wish to bring your attention to the PsoPROTECT (Psoriasis Patient Registry for Outcomes, Therapy and Research Exclusion-Atopic Dermatitis) registries; two urgent global initiatives that address an unmet need for delineating the determinants of COVID-19 outcomes in the common cutaneous immune-mediated inflammatory diseases (IMIDs) psoriasis and atopic dermatitis. The highly transmissible coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created an unprecedented global public health emergency. The pandemic has placed an immense strain on healthcare systems and societal infrastructure worldwide. Most patients exhibit mild-to-moderate symptoms and recover without sequelae, however around 15% develop severe pneumonia and 5% progress to acute respiratory distress syndrome, septic shock and/or multiple organ failure, associated with high mortality 1 . There is an urgent need to better delineate the risk factors leading to poorer outcomes, with emerging data suggesting the elderly and those with pre-existing comorbid conditions such as cardiovascular disease, poorly controlled asthma and diabetes are at highest risk 2 . Although the precise mechanisms by which SARS-CoV-2 causes severe illness are not known, exaggerated innate inflammatory and impaired adaptive immune responses have been observed 1 . Given the immunopathogenesis and treatment paradigm of IMIDs, this group of conditions poses a particular management challenge in the pandemic, and also a potential opportunity to gain insight into the host immune response to the virus. Both psoriasis and atopic dermatitis are associated with multimorbidity and typified by innate and adaptive immune dysregulation, which is targeted by immunomodulatory therapies 3, 4 This article is protected by copyright. All rights reserved potential pathogenic role for upregulated innate antiviral immune responses in psoriasis 3 , however, it is unclear whether this has implications for risk or outcome of COVID-19. To address these gaps, the international clinical, scientific and public health dermatological communities have rapidly connected with the common aim of gathering observational data on COVID-19 outcomes in psoriasis and atopic dermatitis on a global scale. PsoPROTECT (www.psoprotect.org) and SECURE-AD (www.covidderm.org) are web-based registries for clinicians to report COVID-19 outcomes in psoriasis and atopic dermatitis, respectively. They have received robust support from major international dermatological professional and patient organisations, and wide participation of clinicians is now vital. The accumulating prospective observational clinical datasets in PsoPROTECT and SECURE-AD, alongside emerging data in the scientific literature, may help to guide clinical decision making during the pandemic. A key objective is to identify predictors (e.g. immunomodulator medications, comorbidities, demographic variables) of COVID-19 outcomes in psoriasis and atopic dermatitis and to characterise patients in whom it may be beneficial to pause, continue or initiate systemic treatment. Regular open-access summaries of aggregated data will be published online for the benefit of the global clinical and patient community. Researchers are also actively encouraged to apply to utilise the registry data. Importantly, these data have the potential to generate hypotheses on the underlying immunological basis for COVID-19 outcomes, which may inform the development of life-saving treatments and vaccines. The This article is protected by copyright. All rights reserved scientific basis and mode of action of immunomodulators in psoriasis and atopic dermatitis has been rigorously evaluated 3, 4 , so any emerging novel associations of these therapies or disease-specific characteristics with COVID-19 outcomes may provide insight into pathomechanisms of the infection beyond these conditions and dermatology. Subsets of patients will be compared to determine the impacts on COVID-19 outcomes of specific immunomodulators/drug classes, disease severity and demographic variables such as age, sex, ethnicity and geographical regions. Cross-IMID comparisons are also important, since individual diseases may confer differential risks on COVID-19 outcome. The data fields in PsoPROTECT and SECURE-AD case report forms are therefore aligned with those of similar global efforts in rheumatology (https://rheum-covid.org/) and inflammatory bowel disease (https://covidibd.org/). Since treatments such as TNF-antagonists are shared across IMIDs, greater power to infer impact of specific immunomodulators on outcomes may be afforded by combining disease datasets. Any preliminary data should be interpreted with caution, particularly where case numbers are limited. An observational design is necessary for the capture of real-world outcomes in the registries, however there is inevitable potential for bias and incomplete data capture. For instance, clinicians may be more likely to report, and in more severe/complex skin disease, in better-resourced health care systems. In the context of a global case collection, cross-national differences in public health strategies will also need to be accounted for when interpreting outcome data. A limitation of registries relying on spontaneous reporting is a lack of denominator data for each treatment. To help to mitigate this, data from PsoPROTECT and SECURE-AD can be used to enrich existing large-scale pharmacovigilance registries. Subsequent meta-analyses may give more precise estimates of the risks associated with each drug/variable. Patient-reported outcomes of COVID-19, patient experiences and health behaviours during the pandemic are also key considerations for informing clinical care. Therefore, patient-led collections of data will be pursued, with the data fields of the patient case report forms closely matched to those of PsoPROTECT This article is protected by copyright. All rights reserved and SECURE-AD. This will enable inclusion of individuals with milder psoriasis and atopic dermatitis, and also less severe COVID-19 infections, reducing the risk of selection bias. Close international collaboration between clinicians, scientists and patients in the current pandemic is essential to fulfil PsoPROTECT and SECURE-AD's exciting potential to rapidly accrue large-scale datasets with high translational value. The knowledge gained from these efforts will be vital for guiding treatment choices and counselling patients on how to mitigate the potential risk of COVID-19. Please help to inform our common clinical practice in the coming weeks and months by reporting your cases of COVID-19 today. COVID-19: immunopathology and its implications for therapy Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention Update on psoriasis immunopathogenesis and targeted immunotherapy Atopic dermatitis Accepted Article Results From the Psoriasis Longitudinal Assessment and Registry (PSOLAR) Comparative Safety of Systemic Immunomodulatory Medications in Adults with Atopic Dermatitis European Task Force on Atopic Dermatitis (ETFAD) statement on severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2)-infection and atopic dermatitis Baricitinib for COVID-19: a suitable treatment? The PsoPROTECT study team is thankful to Engine Group UK for their generous creative input and website expertise. We acknowledge financial support from the Department of Health via the National Institute for