The study looks at the correlations between COVID-19 and psoriasis

As COVID-19 has brought to light a myriad of health issues, the researchers wanted to find out if there was a relationship between a genetic predisposition to psoriasis and/or systemic treatment for psoriasis and susceptibility to COVID-19. A recent study in Journal of the American Academy of Dermatology1 refutes previous findings that people with psoriasis were more likely to contract COVID-19.2

Recognizing the bidirectional link between psoriasis and infectious diseases and previous speculation regarding COVID-19, Christos V. Chalitsios, PhD, Department of Hygiene and Epidemiology, Faculty of Medicine, University of Ioannina, Greece, and colleagues conducted an updated analysis of Mendelian randomization (MR). Researchers obtained summary statistics on psoriasis from the largest genome-wide association study (GWAS) of Europeans,3 several sensitivity analyzes to examine the MR hypotheses from the previous study,2 and summary genome-wide statistics on COVID-19 from the latest available data (round 7) of the COVID-19 Host Genetics Initiative, which included analysis of all available phenotypes.4

Christos V Chalitsios, PhD, Department of Hygiene and Epidemiology, Faculty of Medicine, University of Ioannina, Greece.

Susceptibility to catching COVID-19 with psoriasis

The GWAS meta-analysis of patients of European ancestry with psoriasis included 13,229 dermatologist-diagnosed cases of psoriasis with 21,543 controls.3 Little evidence was found for horizontal pleiotropy (MR-Egger intercept, P = .499, P = .106, and P = .106). The MR analysis found no association between a genetic predisposition to psoriasis and an increased susceptibility to contracting COVID-19. Even after correcting for outliers, no association with any COVID-19 phenotype was found.

Single nucleotide polymorphism analysis did not reveal any single influencing nucleotide polymorphism. Evaluation of the two-way association showed that having a genetic predisposition to COVID-19 did not increase the risk of developing psoriasis.

Chalitsios et al. used several sensitivity analyzes and none supported a causal association between psoriasis and COVID-19 disease severity. Furthermore, the study results did not support the findings of previous studies by Gu et al2 that a genetic predisposition to psoriasis is associated with a higher degree of susceptibility to contracting, being hospitalized or developing serious illness from COVID-19 in Europeans.

Chalitsios and colleagues explained that the improved data used in their study may be why their results are not congruent with those of the previous MR study.2 There were 13,229 participants in the Chalitsios et al study compared to 3871 participants in the previous study. Similarly, psoriasis was self-reported in the previous study, leading to a high degree of misclassification, and Gu et al did not use the most recent COVID-19 data, which included a significantly higher number of cases.4 Finally, the current study used the more descriptive phenotypes hospitalized versus population COVID-19 and severe versus population COVID-19, whereas the previous study used the less robust COVID-19 versus population phenotype.

Their findings are in line with information from the National Psoriasis Foundation (NPF). In a podcast, Dermatology times Editorial Board member Mark G. Lebwohl, MD, professor and chair emeritus of the Kimberly and Eric J. Waldman Department of Dermatology, Icahn School of Medicine at Mount Sinai in New York, New York, and Stacie Bell, PhD, chief scientific and medical officer at the NPF, said those with psoriasis shouldn’t worry about the disease making them more likely to get COVID-19.5 Psoriasis in general is an overactive, non-immunosuppressed immune system, so I wouldn’t worry about psoriasis setting you up for coronavirus infection, Lebwohl said.

Systemic therapies and severity of COVID-19 cases

In a study of 104 patients, researchers found that patients receiving systemic therapy for psoriasis were not more likely to develop a severe case of COVID-19.6

Their retrospective cohort study used the Research Patient Data Registry to identify patients with psoriasis (International Statistical Classification of Diseases, 10th revision, code L40) and positive COVID-19 reverse polymerase chain reaction, between March and May 2020. Inclusion criteria included receiving systemic therapy for at least 3 months.

According to Lima et al, there were no significant differences in the severe composite outcome [SCO] or other outcomes between patients taking and not taking systemic therapies. 8.3% of patients on biologic therapy, 20% of patients on methotrexate treatment, and 16.4% of patients not on systemic therapy had CB. Adjusting for age and diabetes, systemic therapy remained unassociated with our main outcome (odds ratio, 0.82; 0.21-3.24, P = 0.77).

Comorbidities and demographics were similar between groups receiving systemic therapy and those not receiving therapeutic treatment.

Similar to these findings, Di Yan, MD, Ronald O. Perelman Department of Dermatology, NYU Grossman School of Medicine, New York, New York, and others found that biologic therapies for psoriasis do not increase the risk of developing severe COVID-19.7 Researchers recruited 173 adults with psoriasis and/or psoriatic arthritis from 2 New York City hospitals. Yan et al determined that the use of biologic therapies, including methotrexate, oral glucocorticoids, and apremilast, did not contribute to the increased severity of COVID-19.7 Specifically, for methotrexate-treated patients, 19.0% of patients had COVID-19 and 18.2% had severe COVID-19, while 21.7% were controls. The demographics between the group who contracted COVID-19 and those who did not contract COVID-19 were similar.

Data on psoriasis and severity of COVID-19

The results of these studies do not suggest any correlation between a genetic predisposition to psoriasis or systemic treatment for psoriasis and an increase in the severity of COVID-19 disease. [The] the main message was the finding that patients with psoriasis are not predisposed to be infected or have worse outcomes than COVID-19, Chalitsios said Dermatology times. The most recent recommendations from the American Academy of Dermatology Association include that those currently on systemic treatment for psoriasis who have not tested positive for COVID-19 and are showing no symptoms of the disease should continue their therapy.8

References

  1. Chalitsios CV, Tsilidis KK, Tzoulaki I. Psoriasis and COVID-19: a two-way Mendelian randomization study. J Am Acad Dermatol. 2022;88(4):893-895. doi:10.1016/j.jaad.2022.10.019
  2. Gu X, Chen X, Shen M. Association of psoriasis with risk of COVID-19: a 2-sample Mendelian randomization study. J Am Acad Dermatol. 2022;87(3):715-717 .
  3. Tsoi LC, Stuart PE, Tian C, et al. Large-scale meta-analysis characterizes the genetic architecture for common psoriasis-associated variants. Common Nat. 2017;8:15382. doi:10.1038/ncomms15382
  4. COVID-19 Host Genetics Initiative. The Covid-19 Host Genetics Initiative, a global initiative to clarify the role of host genetic factors in the susceptibility and severity of the SARS-CoV-2 virus pandemic. Eur J Hum Genet. 2020;28(6):715-718. doi:10.1038/s41431-020-0636-6
  5. National Psoriasis Foundation. PsoundBytes. Coronavirus and psoriatic disease: your questions answered. March 27, 2020. Accessed June 8, 2023. https://www.psoriasis.org/watch-and-listen/coronavirus-and-psoriatic-disease-your-questions-answered/
  6. Lima XT, Cueva MA, Lopes EM, Alora MB. Severe outcomes of COVID-19 in patients with psoriasis. J Eur Acad Dermatol Venereol. 2020;34(12):3i776-e778. doi:10.1111/jdv.16867
  7. Yan D, Kolla A, Young T, et al. COVID-19 outcomes in patients with psoriasis and psoriatic arthritis: a prospective cohort study. JAADInt. 2022;8:31-33
  8. Association of the American Academy of Dermatology. Guidelines on the use of drugs during the COVID-19 epidemic. October 2020. Accessed June 9, 2023. https://assets.ctfassets.net/1ny4yoiyrqia/PicgNuD0IpYd9MSOwab47/2461e6c12cd88953632a13cd68952b71/Guidance_on_medications__10-12-20.pdf

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