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, Mark Yates, Sinéad Langan, Zenas Z N Yiu, Teresa Tsakok, Nick Dand, K.J. Mason, Helen McAteer, Freya Meynell, Bola Coker, Alexandra Vincent, Dominic Urmston, A Vesty, J Kelly, Camille Lancelot, Lucy Moorhead, H. Bachelez, Ian N Bruce, Francesca Capon, Claudia Romina Contreras, Andrew P. Cope, C. De La Cruz, Paola Di Meglio, Paolo Gisondi, Kimme L Hyrich, D. Jullien, John S. Lambert, Helena Marzo‐Ortega, Iain B. McInnes, Luigi Naldi, Sam Norton, L. Puig, Raj Sengupta, Phyllis I. Spuls, Tiago Torres, Richard B. Warren, H Waweru, John Weinman, C.E.M. Griffiths, Juliet N. Barker, Matthew A. Brown, James Galloway, Catherine Smith, the PsoProtect, CORE‐UK study groups
Abstract
BACKGROUND: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES: 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 (RMDs) (UK only) between 4 May and 7 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 characterized international variation in a mixed-effects model. RESULTS: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (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 Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (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.