Treatment Adherence in Dermatology During the COVID-19 Pandemic: A Review.

The coronavirus disease 2019 (COVID-19) pandemic raised many challenges for dermatology. Safety is a principal concern for many patients, particularly those on medications that affect the immune system. Understanding how the pandemic affects patients' treatment adherence may be informative for counseling or other interventions to assure that treatment plans are not inappropriately interrupted, or for future pandemics. The purpose of this review was to investigate the extent to which the COVID-19 pandemic affected medication adherence in dermatology. A literature search of PubMed was performed using the search terms: adherence, compliance, dermatology, COVID-19, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and pandemic. Eleven primary research studies met the inclusion criteria and were included in the review. During the COVID-19 pandemic, non-adherence in dermatology patients was primarily linked to concern about the risk of COVID-19 infection with long-term use of immunomodulatory and immunosuppressive medications. In some cases, non-adherence was associated with feelings of depression, anxiety, or perceived stress. High adherence was attributed to regular and convenient communication between patients and dermatology providers through the effective use of telemedicine and electronic messaging. Frequent communication with providers to address patient concerns and provide continuity of care improved adherence. An integrated virtual approach to patient care facilitated this, particularly through the use of telemedicine. Implementation of routine virtual questionnaires was, to some extent, effective in replacing limited in-person patient-provider interactions during the pandemic. Finally, the added threat of the pandemic presented an additional mental health component to consider for patients, supporting the need for a multidisciplinary approach to patient care.

Development and validation of a COVID-19 vaccine hesitancy scale for adults in the United States.

COVID-19 vaccines have been rapidly developed. However, widespread uptake remains a hurdle to a successful pandemic response. A simple, user-friendly survey to measure vaccine hesitancy may facilitate development of interventions aimed at maximizing vaccination. We developed a novel 10-item instrument designed to measure COVID-19 vaccine hesitancy in adults in the United States. We recruited 232 participants through Amazon's Mechanical Turk, an online crowdsourcing platform. The internal consistency (Cronbach's α = 0.89) and temporal stability (r = 0.87; p < 0.001) of our survey was strong. Lower hesitancy (high scores) was associated with higher trust in physicians (r = 0.58; p < 0.001), and higher hesitancy (low scores) was reported with higher belief in conspiracies (r = -0.68; p < 0.001). The correlation between low hesitancy and reported intent to receive (or history of receiving) at least one dose of the COVID-19 vaccine was moderate-strong (r = 0.68; p < 0.001).

The effect of the COVID-19 pandemic on perceptions of teledermatology.

There is limited information of the effect of the COVID-19 pandemic on the general population's perceptions towards teledermatology. This study aims to assess the pandemic's impact on people's willingness to use teledermatology as well as to investigate influencing factors. We recruited 544 participants through Amazon Mechanical Turk (MTurk) and surveyed them using REDCap. Participants' willingness to use teledermatology before, during, and after the COVID-19 pandemic was measured via a 5-point Likert scale. The survey also included questions regarding factors influencing participants' attitudes towards teledermatology and their sociodemographic characteristics. Of the 185 participants who reported unwillingness to use teledermatology prior to the COVID-19 pandemic, 79.2% and 66.5% became either neutral or willing to use teledermatology during and after the pandemic, respectively. Less than half of prior satisfactory telemedicine users reported willingness to use teledermatology before the pandemic; willingness to use teledermatology increased to 80.1% and 63.8% during and after the COVID-19 pandemic, respectively. The top reason for lack of interest in teledermatology was concern for security and privacy (24.4%). Although a useful tool, teledermatology has been met with reluctance by the public. However, the unique circumstances of the COVID-19 pandemic have improved the public's perceptions and readiness to use teledermatology.

The Impact of teledermatology during the COVID-19 pandemic.

Teledermatology has been widely adopted during the COVID-19 pandemic as virtual patient care promotes social distancing and decreases viral exposure risk. As teledermatology has become more prominent during this period, it is essential to assess whether virtual visits allow for adequate patient care. To assess perceptions of advantages and disadvantages of teledermatology, a survey was sent to academic dermatologists through the Association of Professors of Dermatology (APD) listserv. Of the physicians surveyed, 94% reported their departments had implemented teledermatology during the COVID-19 pandemic. The majority (64%) described teledermatology as an effective tool for patient care because of improved access to care, decreased risk of COVID-19 exposure, and convenience. Frequently cited limitations of teledermatology were image quality, technical difficulties, and inability to perform a comprehensive skin examination. Thirty-seven percent of respondents reported teledermatology as a contributor to their professional burnout. Although teledermatology has become more prevalent as a result of the pandemic, its role moving forward is uncertain given its limitations.

Efficacy, Safety and Immunogenicity of AVT02 Versus Originator Adalimumab in Subjects with Moderate to Severe Chronic Plaque Psoriasis: A Multicentre, Double-Blind, Randomised, Parallel Group, Active Control, Phase III Study.

BACKGROUND: AVT02 (adalimumab) is a proposed biosimilar to Humira®. AVT02 is produced at a 100 mg/mL concentration with a citrate-free formulation. OBJECTIVES: The aim of this study was to compare the efficacy, safety and immunogenicity of AVT02 versus Humira® in subjects with moderate to severe chronic plaque psoriasis. METHODS: This double-blind, randomised, parallel group, active control study of adult subjects compared (at a 1:1 ratio) AVT02 with originator adalimumab 80 mg subcutaneously in Week 1, then 40 mg every other week. At Week 16, subjects who had received originator adalimumab were re-randomised at a 1:1 ratio to continue receiving originator adalimumab, or to switch to AVT02, every other week until Week 48, with final efficacy endpoint at Week 50. Subjects who initially received AVT02 continued to receive AVT02 from Week 16 to Week 48. The primary endpoint was percentage improvement in Psoriasis Area and Severity Index (PASI) score at Week 16. Secondary efficacy endpoints included percentage improvement in PASI score at additional timepoints, change from baseline in Dermatology Life Quality Index (DLQI) score and number and percentage of subjects achieving static Physician's Global Assessment (sPGA) responses of 'clear' or 'almost clear'. Additional secondary endpoints included comparison of adverse event profiles, anti-drug antibodies and neutralising antibodies, and serum trough levels of adalimumab at steady state. RESULTS: A total of 413 subjects were randomised (205 to AVT02 and 208 to originator). The percentage improvement in PASI score at Week 16 was 91.6% for AVT02-treated subjects and 89.6% for originator adalimumab. The 90% confidence intervals for the primary endpoint were within the pre-defined equivalence margin of ±10% (90% CI - 0.76 to 5.29; 95% CI - 1.34 to 5.88), and a comparable pattern for DLQI score (11.4-point and 10.6-point improvement in AVT02-treated and originator adalimumab-treated groups, respectively) and sPGA (90.5% in both groups achieving 'clear' or 'almost clear') at Week 16 supported the assessment. Efficacy persisted through Week 50 of the study in all treatment groups, including those who switched from originator adalimumab to AVT02, for percent improvement in PASI score, quality-of-life assessment and sPGA. The safety, tolerability and immunogenicity profiles between AVT02 and originator adalimumab were similar at Week 16, and this persisted in the switched and continued groups through Week 50. CONCLUSION: Objective and subjective measures of efficacy supported the evaluation of biosimilarity between AVT02 and originator adalimumab at Week 16 and until Week 50, in switched and continued treatment groups. AVT02 was safe and well tolerated, with a safety and immunogenicity profile similar to that observed in originator adalimumab with no clinically meaningful difference between the two. CLINICAL TRIAL REGISTRATION: EudraCT: 2017-003367-35; ClinicalTrials.gov: NCT03849404.

The impact of the coronavirus disease 2019 pandemic on dermatologist burnout: a survey study.

Burnout in dermatology is on the rise, with 36% of U.S. dermatologists experiencing burnout in 2020. The coronavirus disease 2019 (COVID-19) pandemic may exacerbate this problem with healthcare workers reporting increased anxiety, depression, and insomnia. To assess the rate, severity, and causes of burnout before and during the pandemic, a survey was sent to academic dermatologists through the Association of Professors of Dermatology (APD) listserv and compared to a similar survey administered to the same population prior to the pandemic. Burnout rates have increased from 2018, with 53% of participants experiencing burnout once a week or more and 17% experiencing burnout daily during the pandemic. The most common COVID-related burnout factors involve uncertainty about the future, teledermatology, fear of exposing loved ones to COVID-19, and compensation reduction. The challenges posed by the COVID-19 pandemic compound existing burnout within dermatology, warranting consideration by academic institutions.

Learning from disease registries during a pandemic: Moving toward an international federation of patient registries.

High-quality dermatology patient registries often require considerable time to develop and produce meaningful data. Development time is influenced by registry complexity and regulatory hurdles that vary significantly nationally and institutionally. The rapid emergence of the coronavirus disease 2019 (COVID-19) global pandemic has challenged health services in an unprecedented manner. Mobilization of the dermatology community in response has included rapid development and deployment of multiple, partially harmonized, international patient registries, reinventing established patient registry timelines. Partnership with patient organizations has demonstrated the critical nature of inclusive patient involvement. This global effort has demonstrated the value, capacity, and necessity for the dermatology community to adopt a more cohesive approach to patient registry development and data sharing that can lead to myriad benefits. These include improved utilization of limited resources, increased data interoperability, improved ability to rapidly collect meaningful data, and shortened response times to generate real-world evidence. We call on the global dermatology community to support the development of an international federation of patient registries to consolidate and operationalize the lessons learned during this pandemic. This will provide an enduring means of applying this knowledge to the maintenance and development of sustainable, coherent, and impactful patient registries of benefit now and in the future.

Dermatology COVID-19 Registries: Updates and Future Directions.

During the COVID-19 pandemic, rapid, real-world evidence is essential for the development of knowledge and subsequent public health response. In dermatology, provider-facing and patient-facing registries focused on COVID-19 have been important sources of research and new information aimed at guiding optimal patient care. The 7 dermatology registries included in this update now include more than 8000 case reports sourced from physicians and patients from countries all over the world.

National Psoriasis Foundation COVID-19 Task Force guidance for management of psoriatic disease during the pandemic: Version 2-Advances in psoriatic disease management, COVID-19 vaccines, and COVID-19 treatments.

OBJECTIVE: To update guidance regarding the management of psoriatic disease during the COVID-19 pandemic. STUDY DESIGN: The task force (TF) includes 18 physician voting members with expertise in dermatology, rheumatology, epidemiology, infectious diseases, and critical care. The TF was supplemented by nonvoting members, which included fellows and National Psoriasis Foundation staff. Clinical questions relevant to the psoriatic disease community were informed by inquiries received by the National Psoriasis Foundation. A Delphi process was conducted. RESULTS: The TF updated evidence for the original 22 statements and added 5 new recommendations. The average of the votes was within the category of agreement for all statements, 13 with high consensus and 14 with moderate consensus. LIMITATIONS: The evidence behind many guidance statements is variable in quality and/or quantity. CONCLUSIONS: These statements provide guidance for the treatment of patients with psoriatic disease on topics including how the disease and its treatments affect COVID-19 risk, how medical care can be optimized during the pandemic, what patients should do to lower their risk of getting infected with severe acute respiratory syndrome coronavirus 2 (including novel vaccination), and what they should do if they develop COVID-19. The guidance is a living document that is continuously updated by the TF as data emerge.

Factors associated with adverse COVID-19 outcomes in patients with psoriasis-insights from a global registry-based study.

BACKGROUND: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. OBJECTIVE: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. METHODS: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. RESULTS: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk 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), nonwhite ethnicity (OR = 3.15; 95% CI = 1.24-8.03), and comorbid chronic lung disease (OR = 3.87; 95% CI = 1.52-9.83). Hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). CONCLUSION: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19-related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates.