Factors associated with hospitalization due to COVID-19 in patients with psoriasis: insights from a global registry

Psoriasis is a common immune-mediated inflammatory skin disease with frequent multimorbidity, and immunosuppressants are the mainstay of treatment in moderate-to-severe disease An understanding of the impact of COVID-19 on individuals with psoriasis and the effect of psoriasis therapies on the course of COVID-19 is urgently required to inform clinical decision-making This study sought to characterize the clinical course of COVID-19 in patients with psoriasis and to identify factors associated with hospitalization Clinicianreported cases of confirmed or suspected COVID-19 in psoriasis were collected via an international online registry Multivariable-adjusted logistic regression identified factors associated with hospitalization Patient risk-mitigating behaviours were characterized using an independent global selfreport registry In total, 334 clinician-reported cases (median age 50 years, 62% male, median body mass index 28 kg m-2, 85% white) from 22 countries [most frequently, the U K (35%), Italy (22%) and Spain (16%)] were available between 27 March and 20 June 2020 Altogether, 245 (73 3%) patients were receiving a biologic, 54 (16 2%) a nonbiologic and 31 (9 3%) no systemic treatment Overall, 311 (93 1%) achieved a full recovery, 71 (21 2%) were hospitalized and nine (2 7%) died Risk factors associated with hospitalization were older age [adjusted odds ratio (aOR) 1 71, 95% confidence interval (CI) 1 26-2 32], male sex (aOR 2 37, 95% CI 1 11-5 04) and nonwhite ethnicity (aOR 3 40, 95% CI 1 27-9 11), in addition to chronic lung disease (aOR 4 37, 95% CI 1 62-11 74) and hypertension (aOR 2 23, 95% CI 1 05-4 74) Reduced risk of hospitalization was associated with use of a biologic (aOR 0 42, 95% CI 0 18-0 98) vs nonbiological systemic therapy There was no difference in risk of hospitalization between classes of biologics An independent selfreport psoriasis registry (1167 patients from 39 countries) suggested increased social isolation (76% vs 66%;P < 0 05) but similar nonadherence to medication (18% vs 22%) in patients receiving biologics vs nonbiological systemic treatments In this international moderate-to-severe psoriasis case series, most patients fully recovered from COVID-19;older age, being male and being of nonwhite ethnicity increased risk of hospitalization Use of biologics, when compared with nonbiological systemic therapies, was associated with reduced risk of hospitalization;however, this requires further study owing to potential selection bias and unmeasured confounding such as a difference in risk-mitigating behaviours