key: cord-0914176-0lihsc06
authors: Georgakopoulos, J.R.; Mufti, A.; Vender, R.; Prajapati, V.H.; Yeung, J.
title: Incidence and prognosis of COVID‐19 in psoriasis patients on biologic therapy: a multicentre retrospective cohort study
date: 2021-05-01
journal: J Eur Acad Dermatol Venereol
DOI: 10.1111/jdv.17279
sha: 950486b0bf00419c867c0f2c7c621c6646d6c53a
doc_id: 914176
cord_uid: 0lihsc06

Current guidelines recommend continuing biologic therapy in dermatologic patients who have not tested positive for or exhibited signs/symptoms of COVID-19 and postponing biologic therapy in patients who have tested positive for or exhibited signs/symptoms of COVID-19.1-3 In order to help guide current recommendations, we aimed to investigate the incidence and prognostic outcomes of positive SARS-CoV-2 infection in psoriasis patients on biologic therapy.

Incidence and prognosis of COVID-19 in psoriasis patients on biologic therapy: a multicentre retrospective cohort study Editor Current guidelines recommend continuing biologic therapy in dermatologic patients who have not tested positive for or exhibited signs/symptoms of COVID-19 and postponing biologic therapy in patients who have tested positive for or exhibited signs/symptoms of COVID-19. [1] [2] [3] In order to help guide current recommendations, we aimed to investigate the incidence and prognostic outcomes of positive SARS-CoV-2 infection in psoriasis patients on biologic therapy.

Following ethics committee approval, a multicentre retrospective cohort study was undertaken at two tertiary academic hospitals and four community practices in Canada. Inclusion criteria were all adult and paediatric patients treated with a biologic for moderate-to-severe psoriasis since COVID-19 was declared a global pandemic. Data were obtained from Patient Support Program (PSP) Case Managers of all major biologic suppliers and patient-reported clinical documentation.

As of 15 January 2021, there were 2647 patients on biologic therapy who met the inclusion criteria. In this cohort, 10 patients (0.4%) had confirmation of SARS-CoV-2 infection via nasal swab. Incidence of COVID-19 was highest in those treated with interleukin (IL)-12/23 inhibitors (3/443, 0.7%) and IL-17a inhibitors (5/667, 0.7%), compared to IL-23 inhibitors (2/799, 0.2%) and tumour necrosis factor-alpha (TNF-a) inhibitors (0/ 738, 0%). Biologic-specific incidence included that of adalimumab (0/336), brodalumab (1/80), certolizumab (0/60), etanercept (0/288), guselkumab (1/530), infliximab (0/54), ixekizumab (3/267), risankizumab (1/269), secukinumab (1/ 320) and ustekinumab (3/443). Of those who tested positive, mean age was 42 AE 15 years, with the majority being male (7/ 10, 70%), Caucasian (7/10, 70%) and on a biologic for over 12 months (7/10, 70%; mean: 34 AE 35 months). Six patients (60%) had symptoms of COVID-19, compared to three patients (40%) who were asymptomatic carriers (Table 1) . Seven patients (70%) discontinued biologic therapy due to COVID-19. Six patients restarted treatment with a mean restart time of 19 AE 10 days, while one patient elected to remain off treatment due to persistently well-controlled disease. The results from this study suggest that patients with moderateto-severe psoriasis on a biologic agent have a similar or perhaps even lower incidence of COVID-19 (10/2647, 0.4%) compared to the general public (1.8%, reported Canada wide rate as of 15 January 2021). This supports current recommendations that psoriasis patients should not discontinue their biologic therapy out of risk or fear of contracting COVID-19. 4, 5 However, these findings contrast prior evidence in a cohort of 1193 psoriasis patients on a biologic, suggesting increased risk of COVID-19 infection. Furthermore, our results suggest good prognosis for COVID-19-positive psoriasis patients on a biologic as symptoms were mild and no patients required oxygenation or hospitalization. 6 This is in contrast to early reports demonstrating psoriasis patients, with and without biologic exposure, are at higher risk of COVID-19 hospitalization and mortality, which may be driven by associated comorbid conditions. 6,7 Permanent discontinuation of biologic therapy due to COVID-19 was uncommon with just one patient holding treatment long term, compared to three patients who did not interrupt therapy and six patients who resumed within four weeks of their confirmed COVID-19 diagnosis.

Limitations of this study include the short-term follow-up and retrospective nature. Although close to 100% of biologic patients in Canada are enrolled in PSPs, we may have potentially missed a rare patient who is not enrolled in PSPs and their diagnosis of COVID-19 was not reported to their dermatologist. In summary, psoriasis patients on a biologic have an incidence of COVID-19 that is no worse than the general public, with TNF-a inhibitors demonstrating the lowest rate of infection. Symptom severity and mortality remain low supporting emerging evidence that interruption of biologic therapy should be reserved for clinically unwell patients. 

None.

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COVID-19 and dermatology: a comprehensive guide for dermatologists

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Concerns and perceptions of patients with psoriatic disease during the COVID-19 pandemic: results from a two-wave survey by the National Psoriasis Foundation

Treatment discontinuation and rate of disease transmission in psoriasis patients receiving biologic therapy during the COVID-19 pandemic: A Canadian multicenter retrospective study

Factors associated with COVID-19-related death using OpenSAFELY

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