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
Pedro Machado, Martin Schäfer, Satveer K. Mahil, Jean W. Liew, Laure Gossec, Nick Dand, Alexander Pfeil, Anja Strangfeld, Anne C. Regierer, Bruno Fautrel, Carla Gimena Alonso, Carla Gonçalves Schahin Saad, C.E.M. Griffiths, C. Lomater, Corinne Miceli‐Richard, Daniel Wendling, D. Alpizar-Rodriguez, Dieter Wiek, Elsa F Mateus, Emily Sirotich, Enrique R. Soriano, Francinne Machado Ribeiro, Felipe Omura, F. R. Martins, Helena Santos, Jonathan Dau, Jonathan N Barker, Jonathan S. Hausmann, Kimme L Hyrich, Lianne S. Gensler, Lígia 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, Zachary S. Wallace, Zenas Z N Yiu, Jinoos Yazdany, Philip C. Robinson, Catherine Smith
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.