Abstracts

Incidence of COVID-19 hospitalization in patients with psoriasis taking systemic immunomodulators

Abstract Process

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Mask group - 2022-12-09T162048.008

Authors

Jonathan Koptyev
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell

Sergey Rekhtman, MD, MPH, PharmD
Donald And Barbara Zucker School Of Medicine At Hofstra/Northwell

Andrew Strunk, MA
Donald And Barbara Zucker School Of Medicine At Hofstra/Northwell

Amit Garg, MD
Donald And Barbara Zucker School Of Medicine At Hofstra/Northwell

George Han, MD, PhD
Donald And Barbara Zucker School Of Medicine At Hofstra/Northwell

Keywords

psoriasis; liver fibrosis; methotrexate; transient elastography

Background:

  • Current research on COVID-19-related outcomes in patients with psoriasis, particularly regarding influence of treatments, is subject to lack of comparator group, selection bias, confounding, and insufficient statistical power.[1]

  • It remains uncertain whether immunomodulatory treatments for psoriasis enhance or decrease the risk of severe COVID-19-related outcomes, including hospitalization.

Objective:

  • To compare the risk of COVID-19-related hospitalization according to immunomodulator treatment type in patients with psoriasis

Methods:

  • Retrospective cohort study of the IBM Explorys database from March 1st, 2020 to December 31st, 2020

  • Drug exposure was classified as biologic, oral immunomodulator, both or neither treatment based on prescription orders between 12/01/2019 and 02/29/2020

  • Biologic drug classes: TNF-alpha, IL-12/IL-23, IL-17A, and IL-23 inhibitors

    • Specific biologic drugs: etanercept, adalimumab, infliximab,

      golimumab, certolizumab, ustekinumab, secukinumab,

      ixekizumab, brodalumab, tildrakizumab, guselkumab,

      risankizumab

  • Oral immunomodulators: methotrexate, cyclosporine, apremilast
  • Primary Outcome: Hospital admission with diagnosis of COVID-19 or positive lab test occurring between admission and discharge
  • Statistical Analysis: Cumulative incidence of COVID-19-related hospitalization was calculated during the study period for each treatment group. Propensity score weighting was used to compare COVID-19-related hospitalization between treatment groups, adjusting for comorbidities and demographic characteristics.

Results:

  • There were 51,974 psoriasis patients eligible for analysis, of whom 2,593 (5%) received biologics, 1,585 (3%) received OIs, 444 (0.9%) received both, and 47,352 (91.1%) received neither.
  • Cumulative incidence of COVID-19-related hospitalization per 1,000 psoriasis patients was 3.1 in the biologics group (8/2,593; 95% CI 1.6-6.1), 9.5 in the OI group (15/1,585; 95% CI 5.7-15.6), 6.8 in those receiving both (3/444; 95% CI 2.3-19.7), and 3.9 in those receiving neither drug class (184/47,352; 95% CI 3.4-4.5).
  • Unadjusted RR of COVID-19-related hospitalization for patients taking methotrexate versus neither treatment was 3.73 (95% CI 2.13-6.51), and propensity score-weighted RR was 2.78 (95% CI 1.47-5.26; p=0.002). This translates to an unadjusted risk difference of +11 (95% CI +3, +18) per 1,000 patients and propensity score-weighted risk difference of +9 (95% CI +1, +17) per 1,000 patients.
  • Unadjusted RR of COVID-19-related hospitalization for patients treated with biologics compared to those treated with OIs was 0.33 (95% CI 0.14-0.77), and propensity score-weighted RR was 0.35 (95% CI 0.14-0.86; p=0.02). This corresponds to an unadjusted risk difference of -6 (95% CI -12, -1) per 1,000 patients and propensity score-weighted risk difference of -6 (95% CI -11, -0.3) per 1,000 patients, favoring biologics.

Conclusion:

  • In this U.S.-based psoriasis patient cohort during the first wave of the COVID-19 pandemic, methotrexate use was associated with a significantly greater risk of COVID-19-related hospitalization relative to no systemic immunomodulatory treatment.

  • Use of biologics was associated with a lower risk of COVID-19-related hospitalization than use of OIs.

  • These data are relevant to dermatologists and other prescribers, as they may encourage infection mitigation strategies such as vaccination and pre-exposure prophylaxis for their psoriasis patients on systemic immunomodulators.

References:

1. Piaserico S, Gisondi P, Cazzaniga S, Di Leo S, Naldi L. Assessing the Risk and Outcome of COVID-19 in Patients with Psoriasis or Psoriatic Arthritis on Biologic Treatment: A Critical Appraisal of the Quality of the Published Evidence. J Invest Dermatol. 2022;142(2):355-363.e7. doi:10.1016/j.jid.2021.04.036