AP-HP, Hôpital Pitié-Salpêtrière, Centre de Pharmaco-épidémiologie (Cephépi), INSERM, CIC-1901, Paris, France.
Service de Dermatologie, Hôpital Victor Dupouy, Argenteuil, France.
Ann Dermatol Venereol. 2023 Jun;150(2):101-108. doi: 10.1016/j.annder.2023.01.005. Epub 2023 Feb 15.
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.
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.
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.
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).
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.
COVID-19 大流行的性质引发了患者和医生对慢性疾病（如银屑病）的免疫抑制治疗对 COVID-19 重症风险的潜在影响的担忧。
描述大流行第一波期间银屑病患者的治疗改变，并确定 COVID-19 感染的发生率，同时确定与这些事件相关的因素。
使用 PSOBIOTEQ 队列中与法国 COVID-19 大流行第一波（2020 年 3 月至 6 月）相关的数据，以及一项以患者为中心的 COVID-19 调查问卷，评估封锁对系统性治疗改变（停药、延迟或减少）的影响，并确定这些患者的 COVID-19 病例发生率。使用逻辑回归模型评估相关因素。
在 1751 名应答者（89.3%）中，282 名（16.9%）患者改变了其银屑病的系统性治疗，其中 46.0%的改变是由患者自己发起的。如果这些患者在这段时间内改变治疗，他们更有可能在第一波期间出现银屑病发作（58.7%比 14.4%；P<0.0001）。心血管疾病患者（P<0.001）和年龄≥65 岁的患者（P=0.02）更不太可能改变系统性治疗。总体而言，45 名（2.9%）患者报告患有 COVID-19，8 名（17.8%）需要住院治疗。COVID-19 感染的危险因素是与阳性病例的密切接触（P<0.001）和居住在 COVID-19 发病率高的地区（P<0.001）。COVID-19 风险较低的相关因素是避免看医生（P=0.002）、外出时系统地戴口罩（P=0.011）和当前吸烟（P=0.046）。
在 COVID-19 大流行第一波期间（16.9%）停止系统性银屑病治疗-主要由患者自己决定（46.0%）-与疾病发作发生率较高（58.7%比 14.4%）相关。这一观察结果和与 COVID-19 风险较高相关的因素突出表明，需要根据患者的特征在卫生危机期间维持和调整医患沟通，以避免不必要的治疗中断，并确保患者了解感染风险和遵守卫生规则的重要性。
