Glucocorticoid use, male sex predict more severe COVID-19 in psoriatic disease, axial SpA
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Glucocorticoid use, older age, male sex and comorbidity burden are among the predictors of more severe COVID-19 in patients with psoriasis, psoriatic arthritis or axial spondyloarthritis, according to data.
“While risk factors for severe COVID-19 outcomes have been demonstrated in both registry-based and population-based studies, for people with IMIDs collectively and for specific diseases such as rheumatoid arthritis, relevant risk factor data are limited for axial spondyloarthritis (axSpA) and psoriatic disease (including psoriasis without arthritis (PsO) and psoriatic arthritis (PsA)),” Pedro M. Machado, MD, of University College London, and colleagues wrote in Annals of the Rheumatic Diseases.
“The association of specific classes of [biological or targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs)] commonly used in this population, including IL-17 inhibitors (IL17i) and IL-23 or IL-12/23 inhibitors (IL-23i/IL-12+23i), with COVID-19 outcomes has not been well studied,” they added. “Improved understanding of the risks associated with exposure to these medications in this population will address knowledge gaps as we continue to navigate COVID-19 risks in the postvaccination era.”
To investigate factors associated with severe COVID-19 outcomes in patients with psoriasis, PsA or axial SpA, Machado and colleagues collected data from the COVID-19 Global Rheumatology Alliance and the Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection (PsoProtect) — both physician-sourced registries launched in March 2020. The researchers used data collected on or before Oct. 25, 2021, and patients were classified as having a confirmed or “high likelihood” of COVID-19 based on imaging or tests or presumptive cases based on symptoms.
Therapies used to manage immune-mediated inflammatory diseases were classified according to drug type. The primary outcome was the severity of COVID-19 as assessed on an ordinal scale that included three distinct categories — no hospitalization and no death, hospitalization but no death, and death.
The analysis included a total of 5,045 patients, 18.3% of whom demonstrated psoriasis, 45.5% had PsA and 36.3% had axial SpA. According to the researchers, 83.6% of patients were not hospitalized, 14.6% were hospitalized, and 1.8% of patients died.
Factors associated with more severe outcomes included male sex (OR = 1.54; 95% CI, 1.3-1.83); comorbidities relating to cancer, cardiovascular disease, respiratory disease, renal or metabolic factors (ORs ranging from 1.25 to 2.89); and glucocorticoid use and/or moderate-to-high disease activity (ORs ranging from 1.39 to 2.23 vs. remission or low disease activity and no glucocorticoid use). In addition, infections occurring later in the pandemic or in patients with psoriasis appeared to be less severe, according to the researchers.
“In this registry-based study of individuals with PsO, PsA and axSpA with SARS-CoV-2 infection, we found that known risk factors for the general population (older age, the presence of comorbidities) and for IMIDs overall (higher disease activity, higher baseline [glucocorticoid] usage) were associated with more severe COVID-19 outcomes,” Machado and colleagues wrote. “In addition, a diagnosis of COVID-19 in a later time period during the pandemic was associated with lower disease severity compared with early 2020.”
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