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.

Impact of the COVID-19 pandemic on children with psoriasis.

BACKGROUND: Children with psoriasis may have been directly impacted by the COVID-19 pandemic and their illness may also have affected their ability to follow preventive measures. OBJECTIVE: To investigate the impact of the COVID-19 pandemic on children with psoriasis. METHODS: A survey of children (<18 years) with psoriasis, conducted from June 10 to June 29, 2020. RESULTS: In total, 92 children were included: 71.7% had psoriasis lesions at the time of home lockdown while 45.2% were receiving systemic treatments, and two contracted COVID-19. During lockdown, psoriasis worsened in 47.3% of the children and 18.8% stopped their systemic treatments, mainly for reasons linked to the pandemic. A total of 41.3% had a consultation for psoriasis during lockdown (71.1% by teleconsultation): 39.5% due to worsening of their psoriasis and 21.1% for pandemic-related issues. Among patients not having a consultation during lockdown, 27.5% had a cancellation by the doctor and 9.3% had concerns over going to see the doctor. Finally, 22.8% of patients reported finding it difficult to respect hygiene measures because of their psoriasis, e.g., application of alcohol-based hand sanitizers (47.6%), handwashing routines (42.9%), and wearing a mask (28.6%). CONCLUSIONS: This study demonstrates the major clinical impact of the COVID-19 pandemic on children with psoriasis. Teleconsultations played a key role in patient management as regards patient monitoring, provision of information, and renewal of treatments. It is vital that we learn from these data to improve and adapt the monitoring of chronic dermatoses in both children and adults in the event of a future health crisis.

Acute acral eruptions in children during the COVID-19 pandemic: Characteristics of 103 children and their family clusters.

BACKGROUND: A marked increase in frequency of acute acral eruptions (AAE) was observed in children during the COVID-19 pandemic in the spring period. OBJECTIVES: In this observational multicenter study, based on children with AAE, we aimed to assess the proportion of household members possibly infected by SARS-CoV-2. METHODS: We collected data from all children observed with AAE, prospectively from April 7, 2020 to June 22, 2020, and retrospectively since February 28, 2020. The primary outcome was the household infection rate, defined as the proportion of family clusters having at least one member with COVID-19 infection other than the child with AAE ("index child"). The definition of a case was based on characteristic clinical signs and a positive PCR or serology. RESULTS: The study included 103 children in 10 French departments and in Quebec. The median age was 13 years and the interquartile range [8-15], with a female-to-male ratio of 1/1.15. In children with AAE, all PCR tests were negative (n=18), and serology was positive in 2/14 (14.3%) cases. We found no significant anomalies in the lab results. A total of 66 of the 103 families (64.1%) of included children had at least one other infected member apart from the index child. The total number of household members was 292, of whom 119 (40.8%) were considered possibly infected by SARS-CoV-2. No index children or households exhibited severe COVID-19. DISCUSSION: Among the 103 households included, 64.1% had at least one infected member. Neither children with AAE nor their households showed severe COVID-19.

Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey.

BACKGROUND: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. OBJECTIVES: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. METHODS: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. RESULTS: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations. CONCLUSIONS: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues.

Incidence et pronostic de la COVID-19 chez les malades atteints de maladie bulleuse auto-immune

Introduction Les patients ayant une maladie bulleuse auto-immune (MBAI) étant à risque d’infection (âge, traitement corticoïde et/ou immunosuppresseur), nous avons évalué le risque de la COVID-19 et de ses formes sévères chez les patients ayant une MBAI. Matériel et méthodes Cette étude rétrospective multicentrique (49 services de dermatologie) a inclus tous les cas connus de COVID survenus entre janvier et juin 2020 en France métropolitaine. Les cas ont été classés en certains (PCR+), probables (PCR− ou non faite, TDM pulmonaire évocateur) ou possibles (PCR et TDM négatifs ou non faits mais signes cliniques et/ou cas contacts). L’incidence cumulée des cas de COVID a été calculée à partir des cas certains et hospitalisés de patients MBAI suivis dans chaque service, puis comparée à celle dans la population générale sur la même période (données Santé Publique France) après standardisation indirecte sur l’âge et la région. L’incidence et le pronostic ont été analysés pour l’ensemble des MBAI et pour le sous-groupe ayant reçu du rituximab (RTX) dans les 9 derniers mois. Résultats Incidence : 59 cas de COVID-19 ont été recensés (âge : 73,1±16,2 ans) parmi 5180 patients suivis pour une MBAI : 29 (49 %) correspondaient à des cas certains, 8 (14 %) probables et 22 (37 %) possibles. Les MBAI étaient une PB (n=21, 36 %), une P muqueuse (PM) (PC/EBA, n=19, 32 %), un pemphigus (n=18, 31 %) et 1 P gestationnelle (n=1, 2 %). Le ratio d’incidence standardisé (RIS) était de 0,42 [IC95 % : 0,20–0,80] p=0,005 pour les PB, 1,02 [0,37–2,26], p=0,91 pour les pemphigus et de 1,18 [0,55–2,23], p=0,62 pour les PM. Parmi les 516 patients ayant reçu du RTX, on comptait 22 cas possibles probables ou certains d’infection COVID correspondant à un RI=5,37 [3,15–8,96], parmi lesquels 13 cas probables ou certains (RI=4,90 [2,43–9,40]) par rapport aux patients n’ayant pas reçu de RTX, et un RI de formes certaines et hospitalisées de 3,62 [1,29–8,85]. Pronostic 30 cas (51 %) ont été hospitalisés pour COVID et 15 (25 %) sont décédés (RR=1,63 [0,83–2,55] p=0,13 par rapport à la population générale ajustée à l’âge et à la région. Un patient MBAI avait 3,4 [2,2–5,1] fois plus de risque de décéder sur la période épidémique s’il contractait la COVID que s’il ne la contractait pas. L’âge moyen des patients ayant une forme sévère (hospitalisation ou décès) de COVID était plus élevé que celui de ceux ayant une forme non sévère (77,9±11,2 vs 65,0±19,3, p=0,006). Les RR de forme sévère des PM/pemphigus avec COVID probable ou certaine traités par RTX (âge moyen 68,8±14,9) étaient respectivement de 0,77 [0,45–1,33] p=0,33 et de 0,51 [0,08–2,56] p=0,40 par rapport aux PM/pemphigus avec COVID non traités par RTX (âge moyen 76,7±9,1). Discussion La COVID entraîne une forte surmortalité chez les patients MBAI. L’incidence semble particulièrement élevée parmi les patients ayant reçu du RTX, sans que l’on puisse conclure à une plus grande sévérité de la COVID-19 chez ces patients.