Impact of the first wave of the COVID-19 pandemic on the treatment of psoriasis with systemic therapies in France: results from the PSOBIOTEQ cohort

Background The nature of the COVID-19 pandemic led to concerns among patients and physicians about the potential impact of immunosuppressive treatments for chronic diseases such as psoriasis on the risk of severe COVID-19. Objectives To describe treatment modifications and determine the incidence of COVID-19 infection among psoriasis patients during the first wave of the pandemic, and identify the factors associated with these events. Methods Data from PSOBIOTEQ cohort relating to the first COVID-19 wave in France (March to June, 2020), as well as a patient-centred COVID-19 questionnaire, were used to evaluate the impact of lockdown on changes (discontinuations, delays or reductions) in systemic therapies, and to determine the incidence of COVID-19 cases among these patients. Logistic regression models were used to assess associated factors. Results Among the 1751 respondents (89.3%), 282 patients (16.9%) changed their systemic treatment for psoriasis, with 46.0% of these changes being initiated by the patients themselves. Patients were more likely to experience psoriasis flare-ups during the first wave if they changed their treatment during this period (58.7% vs 14.4%;P<0.0001). Changes to systemic therapies were less frequent among patients with cardiovascular diseases (P<0.001), and those aged ≥65 years (P=0.02). Overall, 45 patients (2.9%) reported having COVID-19, and eight (17.8%) required hospitalization. Risk factors for COVID-19 infection were close contact with a positive case (P<0.001) and living in a region with a high incidence of COVID-19 (P<0.001). Factors associated with a lower risk of COVID-19 were avoiding seeing a physician (P=0.002), systematically wearing a mask during outings (P=0.011) and being a current smoker (P=0.046). Conclusions Discontinuation of systemic psoriasis treatments during the first COVID-19 wave (16.9%) – mainly decided by patients themselves (46.0%) – was associated with a higher incidence of disease flares (58.7% vs 14.4%). This observation and factors associated with a higher risk of COVID-19 highlight the need to maintain and adapt patient–physician communication during health crises according to patient profiles, with the aim of avoiding unnecessary treatment discontinuations and ensuring that patients are informed about the risk of infection and the importance of complying with hygiene rules.

Impact of the first wave of the COVID-19 pandemic on the treatment of psoriasis with systemic therapies in France: Results from the PSOBIOTEQ cohort.

BACKGROUND: The nature of the COVID-19 pandemic led to concerns among patients and physicians about the potential impact of immunosuppressive treatments for chronic diseases such as psoriasis on the risk of severe COVID-19. OBJECTIVES: To describe treatment modifications and determine the incidence of COVID-19 infection among psoriasis patients during the first wave of the pandemic, and identify the factors associated with these events. METHODS: Data from PSOBIOTEQ cohort relating to the first COVID-19 wave in France (March to June, 2020), as well as a patient-centred COVID-19 questionnaire, were used to evaluate the impact of lockdown on changes (discontinuations, delays or reductions) in systemic therapies, and to determine the incidence of COVID-19 cases among these patients. Logistic regression models were used to assess associated factors. RESULTS: Among the 1751 respondents (89.3%), 282 patients (16.9%) changed their systemic treatment for psoriasis, with 46.0% of these changes being initiated by the patients themselves. Patients were more likely to experience psoriasis flare-ups during the first wave if they changed their treatment during this period (58.7% vs 14.4%; P < 0.0001). Changes to systemic therapies were less frequent among patients with cardiovascular diseases (P < 0.001), and those aged ≥ 65 years (P = 0.02). Overall, 45 patients (2.9%) reported having COVID-19, and eight (17.8%) required hospitalization. Risk factors for COVID-19 infection were close contact with a positive case (P < 0.001) and living in a region with a high incidence of COVID-19 (P < 0.001). Factors associated with a lower risk of COVID-19 were avoiding seeing a physician (P = 0.002), systematically wearing a mask during outings (P = 0.011) and being a current smoker (P = 0.046). CONCLUSIONS: Discontinuation of systemic psoriasis treatments during the first COVID-19 wave (16.9%) - mainly decided by patients themselves (46.0%) - was associated with a higher incidence of disease flares (58.7% vs 14.4%). This observation and factors associated with a higher risk of COVID-19 highlight the need to maintain and adapt patient-physician communication during health crises according to patient profiles, with the aim of avoiding unnecessary treatment discontinuations and ensuring that patients are informed about the risk of infection and the importance of complying with hygiene rules.

Granulomatous Pleuritis in a Previously Covid-19-Infected Patient

INTRODUCTION: The most common setting for granulomatous pleuritis is usually in the presence of Mycobacterium tuberculosis. This pathology draws interest due to its potential of long-term injury to lung pleura, as well as, the potential to harm the lung parenchyma by association. We present a rare presentation of granulomatous pleuritis following COVID19 infection. DESCRIPTION: The patient is a 28-year-old female who presents to the hospital with fever and malaise for one week. She reports having an outpatient CT which showed a large right pleural effusion so her pulmonologist instructed her to come in. She denies recent exposure to any sick contacts. She does note a history of COVID-19 a year ago which resulted in shortness of breath but did not require hospitalization. She has worked at a gun shooting range for the last two years, for which she assembles bullets. She notes that she is required to wear a particulate protection mask and has worn this consistently to limit exposure. Thoracic surgery was consulted and initially completed a thoracentesis with 500 mL of exudative fluid. Patient remained intermittently febrile with worsening right sided chest pain. Culture and gram stain were unremarkable. She subsequently underwent a bronchoscopy with bronchial washing, biopsy, and decortication. Pathology demonstrated non-necrotic granulomatous pleuritis with a small area of central fibrinoid necrosis. Repeat chest x-rays demonstrated a minimal pleural effusion, much improved from prior. Fevers had also subsided at this time. Patient was discharged home with instructions to follow-up with thoracic surgery regarding further management of steroids. DISCUSSION: The findings of non-tuberculosis-related granulomatous pleuritis are unique in that they frame the need to look for different perspectives and potentiators for pleural pathology. This case is also important given the unique presentation of the post-covid inflammatory response. Since COVID-19 is still so new, the field of post covid syndromes remains largely unknown.

Impact de la pandémie COVID-19 sur la prise en charge des patients adultes atteints de dermatite atopique modérée à sévère : analyse complémentaire de l'étude MOVE

Introduction: La pandémie COVID-19 a débuté quelque mois après le début de l'étude MOVE, étude visant à décrire les modalités d'utilisation en vie réelle du dupilumab chez les patients adultes atteints de dermatite atopique (DA) modérée à sévère. En France, des mesures de confinement strictes ont été adoptées pour limiter l'expansion de l'infection, puis différentes périodes ont suivi: déconfinement, restrictions sanitaires… Au cours de ces différentes périodes, après une phase initiale de sidération pendant laquelle l'initiation de traitements systémiques a été réduite, les experts et sociétés savantes ont été unanimes sur l'absence de risque d'immunosuppression du dupilumab du fait de son mécanisme d'action. Son utilisation a donc été poursuivie. L'objectif de cette analyse complémentaire était de décrire l'impact de la pandémie sur la prise en charge thérapeutique des patients adultes atteints de dermatite atopique (DA) modérée à sévère. Matériel et méthodes: Une comparaison a été effectuée parmi les 594 patients de l'étude MOVE entre ceux dont le traitement par dupilumab a été initié avant le premier confinement (17 mars 2020) et ceux dont le traitement a été initié après, afin de comparer leurs caractéristiques et leurs traitements systémiques antérieurs. Résultats: Cent cinquante-trois patients (25,8 %) avaient débuté le traitement par dupilumab avant le 17 mars 2020 : 100 (65,4 %) avaient eu une prescription antérieure de ciclosporine A (CsA) ;441 patients (74,2 %) avaient débuté le traitement par dupilumab après le début du confinement : 191 (43,3 %) avaient eu une prescription antérieure de CsA. À partir du confinement, la CsA n'a pas été prescrite pour des raisons liées à la pandémie pour 67 patients sur 233 (30,0 %), et la CsA a été arrêtée chez 8 patients sur 15 (53,3 %) pour les mêmes raisons. Au total, parmi les 594 patients éligibles, la contre-indication circonstancielle (risque d'infection COVID-19) a été le motif rapporté spontanément par les médecins observateurs pour 77 patients (12,7 %) pour expliquer soit la non-prescription : 8 patients (1,3 %), soit l'arrêt de CsA : 69 patients (11,6 %). Discussion: La pandémie COVID-19 a eu un impact sur la prescription de CsA chez les patients adultes atteints de DA modérée à sévère à partir de mars 2020. La contre-indication circonstancielle a été déclarée spontanément par les médecins observateurs, et est probablement sous-estimée dans ces résultats. Cette étude montre que, malgré ces circonstances exceptionnelles, les modalités de prescription du dupilumab étaient, pour la majorité des patients, conformes à son périmètre de remboursement.

Situations of family vulnerability and the COVID-19 pandemic

Context: Aware of the difficulties caused by the COVID-19 pandemic for many families with children aged 6 or under, this study focuses on three contexts of potential vulnerability: single parenthood, children with developmental disorders, poverty. Method: A questionnaire, consisting of 69 questions, was transmitted nationally during the first lockdown (from 17 March to 10 May 2020). Among the study sample (n = 490), 36 households were single-parent, and 93 families had a child with developmental impairments. From November 2020 to June 2021, a additional qualitative approach was used to reach the most vulnerable groups (n = 23). Results: The methodology adopted made it possible to identify modes of experience that converge across families in the three contexts (more strengthened intrafamily relationships and investment in protection measures, for example), and others that appear more specific: pressure felt and need for information for single-parent households and those with children with developmental disorders, the burden of home schooling for single-parent households and the poorest, social isolation for single-parent households and difficulties in maintaining the previous food budget for the most precarious. Conclusion: The various pressures felt, the housing (with or without outdoor spaces) and working conditions, the fear of being sick, the negative feelings, etc. must encourage public authorities to implement psychological support mechanisms, particularly for the most vulnerable parents, in order to avoid subsequent physical and/or psychological health problems or even post-traumatic symptoms for parents and their children. © 2022 Société Française de Psychologie Contexte: Conscient·e·s des difficultés engendrées par la pandémie de COVID-19 pour de nombreuses familles ayant des enfants de 6 ans ou moins, l’étude se focalise sur trois contextes de vulnérabilités familiales : familles monoparentales, avec enfants ayant des difficultés développementales et celles en situation de pauvreté. Méthode: Un questionnaire, composé de 69 questions, a été transmis, au niveau national durant le premier confinement (du 17 mars au 10 mai 2020). Parmi l’échantillon d’étude (n = 490), 36 foyers sont monoparentaux et 93 familles ont un enfant présentant des difficultés développementales. De novembre 2020 à juin 2021, une approche qualitative complémentaire a été menée pour atteindre les publics les plus pauvres (n = 23). Résultats: La méthodologie mixte adoptée permet de relever des modalités du vécu qui rassemblent les familles dans les trois contextes (relations intrafamiliales davantage renforcées et investissement des mesures de protection, par exemple), et d'autres qui apparaissent plus spécifiques : pression ressentie et besoin d'informations pour les foyers monoparentaux et avec enfants à difficultés développementales, charge liée à l’école à la maison pour les foyers monoparentaux et les plus pauvres, isolement social pour les foyers monoparentaux, difficultés à maintenir le budget alimentaire antérieur pour les plus pauvres. Conclusion: Les diverses pressions ressenties, les conditions de logement (avec ou sans espaces extérieurs) et de travail, la crainte d’être malades, les sentiments négatifs, etc. doivent inciter les pouvoirs publics à mettre en œuvre des dispositifs de soutien psychologique, notamment pour les foyers les plus vulnérables afin que n'adviennent pas des problèmes de santé physique et/ou psychique ultérieurs voire des symptômes post-traumatiques des parents et de leurs enfants. © 2022 Société Française de Psychologie

Detection of SARS-CoV-2 antibodies using commercial assays and seroconversion patterns in hospitalized patients.

OBJECTIVES: SARS-CoV-2 antibody assays are needed for serological surveys and as a complement to molecular tests to confirm COVID-19. However, the kinetics of the humoral response against SARS-CoV-2 remains poorly described and relies on the performance of the different serological tests. METHODS: In this study, we evaluated the performance of six CE-marked point-of-care tests (POC) and three ELISA assays for the diagnosis of COVID-19 by exploring seroconversions in hospitalized patients who tested positive for SARS-CoV-2 RNA. RESULTS: Both the ELISA and POC tests were able to detect SARS-CoV-2 antibodies in at least half of the samples collected seven days or more after the onset of symptoms. After 15 days, the rate of detection rose to over 80% but without reaching 100%, irrespective of the test used. More than 90% of the samples collected after 15 days tested positive using the iSIA and Accu-Tell® POC tests and the ID.Vet IgG ELISA assay. Seroconversion was observed 5 to 12 days after the onset of symptoms. Three assays suffer from a specificity below 90% (EUROIMMUN IgG and IgA, UNscience, Zhuhai Livzon). CONCLUSIONS: The second week of COVID-19 seems to be the best period for assessing the sensitivity of commercial serological assays. To achieve an early diagnosis of COVID-19 based on antibody detection, a dual challenge must be met: the immunodiagnostic window period must be shortened and an optimal specificity must be conserved.