Biologic Agent Use Associated With Lower Hospitalization Risk for Patients With Psoriasis and COVID-19

The course of COVID-19 in patients with psoriasis was characterized and factors associated with hospitalization were identified in an international case study.

The use of biologic agents among patients with moderate to severe psoriasis infected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), was associated with a lower risk for COVID-19-related hospitalization compared with patients who used non-biologic system agents, according to findings from a registry analysis published in the Journal of Allergy and Clinical Immunology.

There were 2 data sources reviewed in this registry-based study: the international Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 infecTion (PsoProtect) and the self-report patient-facing registry PsoProtectMe. The PsoProtect included clinician-reported diagnoses of confirmed or suspected COVID-19 in patients with psoriasis, whereas the patient-facing registry provided data on risk-mitigating behaviors.

There was a total of 374 clinician-reported patients with psoriasis and suspected/confirmed COVID-19 from 25 countries. Approximately 71% of these patients were receiving a biologic agent, whereas 18% of patients were receiving a non-biologic agent and 10% were receiving no systemic therapy for psoriasis. The majority of patients in the registry (93%) fully recovered from COVID-19. About 21% (n=77) of patients were hospitalized, and 2% (n=9) died.

An increased risk for hospitalization was associated with older age (multivariable-adjusted odds ratio [OR], 1.59 per 10 years; 95% CI, 1.19-2.13), male sex (OR, 2.51; 95% CI, 1.23-5.12), non-white ethnicity (OR, 3.15; 95% CI, 1.24-8.03), and comorbid chronic lung disease (OR, 3.87; 95% CI, 1.52-9.83).

Patients in the PsoProtect registry who used non-biologic systemic therapies were more frequently hospitalized compared with patients who received biologic agents (OR, 2.84; 95% CI, 1.31-6.18).

In the PsoProtectMe registry including 1626 patients from 48 countries who provided self-reported data, the researchers found lower levels of social isolation in patients who received non-biologic systemic therapy vs biologic agents (OR 0.68; 95% CI, 0.50-0.94).

A limitation of this study is its potential lack of generalizability, due to the inclusion of only patients with moderate to severe psoriasis and the high volume of patients from Spain, Italy, and the United Kingdom.

The investigators of this study emphasize that more data are necessary “to clarify these observations before any recommendations for changes in clinical practice can be considered,” adding that “further investigation of the observed differential rate of hospitalization between different classes of biologics is warranted.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Mahil SK, Dand N, Mason KJ, et al. Factors associated with adverse COVID-19 outcomes in patients with psoriasis – insights from a global registry-based study. Published online October 16, 2020. J Allergy Clin Immunol. doi:10.1016/j.jaci.2020.10.007