COVID-19: Disease Severity Not Increased With Systemic Psoriasis Therapy Use

A patient under respiratory assistance is escorted to the Strasbourg University Hospital by members of the medical staff of the SAMU-SMUR emergency services who wear protective suits and facemasks, in Strasbourg, on March 16, 2020 during a COVID-19 outbreak hitting Europe. – French president will speak on television at 8:00 (Paris time) on March 16, 2020 to announce new measures to fight the growing coronavirus epidemic, said the Elysee. The balance sheet of the epidemic climbed to 127 dead and 5,423 confirmed cases in France. (Photo by Patrick HERTZOG / AFP) (Photo by PATRICK HERTZOG/AFP via Getty Images)
A retrospective cohort study was used to identify patients with both psoriasis and a positive COVID-19 RT-PCR from March through May 2020.

Treatment with systemic psoriasis therapy does not worsen the severity of coronavirus disease 2019 (COVID-19), researchers reported via study findings published in the Journal of the European Academy of Dermatology and Venereology.

The retrospective cohort study used RPDR, a clinical data registry, to identify patients with psoriasis and positive COVID-19 reverse transcription polymerase chain reaction (RT-PCR) from March through May 2020. Patients had received systemic psoriasis therapy for at least 3 months before COVID-19 diagnosis, and the primary outcome was a composite of intensive care unit (ICU) admission, intubation, and/or death.

The investigators used logistic regression to assess the association of therapy status with COVID-19 severe composite outcome and adjusted for age and diabetes. Propensity score was calculated as a predicted probability of receiving or not receiving systemic treatment as a function of all clinically relevant variables.

The study included 104 patients. Among the 37 patients receiving systemic therapy (mean age, 55.1±16 years; 56.8% men; 70.3% White), 27 patients were using biologic agents (18 on anti-TNFα; 4 on anti-IL17; 3 on anti-IL12/23; and 2 on anti-IL23). A total of 13 patients were receiving methotrexate (10 mg/week-22.5 mg/week), and 3 patients were taking both biologic agents and methotrexate.

The researchers found no significant differences in the severe composite outcome or other outcomes in patients taking systemic therapies and those not taking systemic therapies; 8.3% of patients on biologic agents, 20% of patients on methotrexate, and 16.4% of patients not on systemic therapy had the severe composite outcome. Older patients and the presence of diabetes, hypertension, cardiovascular disease, and renal disease significantly increased the odds ratio (OR) of developing the severe positive outcome.

After adjusting for age and diabetes, the study authors found that no association remained between systemic therapy and the main outcome (OR 0.82, 0.21-3.24, P =.77). In another model, all covariates were balanced in exposure groups after adjusting for the propensity score, and no association remained between systemic treatment and the severe composite outcome (OR 0.91, 0.17-4.81, P =.92).

“Amidst this pandemic, dermatologists have to decide whether holding psoriasis therapies may protect patients or trigger a cytokine storm,” the researchers commented. “In our study, we did not find increased rates of severe COVID-19 in patients receiving systemic therapy.”

Because confirmation of COVID-19 by PCR testing was required, patients with more severe infection may have been included and 15 patients were admitted to an ICU, intubated, and/or died. These percentages were similar in both exposure groups, however.

“Detection of COVID-confirmed severe outcomes in [a] psoriasis population and detailed information on significant covariates allowed evaluation of crude and adjusted effect of systemic therapy,” the investigators commented. “Our study suggests that systemic psoriasis therapy does not worsen COVID-19.”

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


Lima XY, Cueva MA, Lopes EM, Alora MB. Severe COVID-19 outcomes in patients with psoriasis. Published online August 11, 2020. J Eur Acad Dermatol Venereol. doi: 10.1111/jdv.16867