Incidence and prognosis of COVID-19 in patients with psoriasis on apremilast: a multicentre retrospective cohort study

Exacerbated systemic signs/symptoms, including respiratory distress, with SARS-CoV-2 infection (COVID-19) has been linked to a disruption in the balance of pro- and anti-inflammatory cytokines.[1] The effect of immunomodulatory therapies on the clinical course of COVID-19 remains under investigation. Limited studies report no increase in incidence of infection or risk of developing severe COVID-19 symptoms in patients with psoriasis treated with biologic agents.[2-5] Apremilast is an oral phosphodiesterase-4 inhibitor approved for the treatment of chronic plaque psoriasis, psoriatic arthritis, and Behcet's disease. Contrary to patients' concerns about the use of immunomodulatory agents during the COVID-19 pandemic, data from 3 Canadian dermatology practices showed that patients did not discontinue apremilast due to such concerns.[6] The risk of contracting SARS-CoV-2 in patients receiving apremilast treatment, however, remains unknown. Accordingly, we aimed to quantify the proportion of patients with psoriasis who contracted COVID-19 during treatment with apremilast.