Ghoreishi Amin Nazila, Khosravi Sepehr, Atefi Najmolsadat, Seirafianpour Farnoosh, Farhoodi Sahand, Goodarzi Azadeh
Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, California, USA.
Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
Immun Inflamm Dis. 2023 Nov;11(11):e1063. doi: 10.1002/iid3.1063.
This systematic review and meta-analysis aims to investigate the mutual impact of COVID-19 and psoriasis to inform clinical practice and future research.
We followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis protocol for systematic reviews and searched PubMed, Web of Science, Scopus, and Google Scholar until May 1, 2022. Eligibility criteria included full-text articles in English reporting COVID-19 treatment outcomes in psoriasis patients. Studies on animals, letters to editors, non-English studies, and studies with no access to full articles were excluded. Search results were screened and data were extracted by two groups of reviewers with any discrepancies resolved by the senior author. The risk of bias was assessed using ROBINS-I for nonrandomized studies. The hospitalization rate, Intensive Care Unit (ICU) admission rate, case fatality rate, odds ratios of COVID-19 infection and hospitalization rate in psoriasis patients were extracted and analyzed using random effects analysis to calculate pooled prevalence and odds ratios, as well as to explore heterogeneity.
We found 1980 records from four databases and included 20 studies after screening and removing duplicates. These studies evaluated 185,000 psoriasis patients and included eight retrospective cohort studies, one case-control study, three cross-sectional studies, and eight case series studies. The impact of the COVID-19 pandemic on psoriasis treatment and the outcome of COVID-19 infection in psoriasis patients receiving different forms of treatment were evaluated. The pooled data from included studies showed that the incidence rate of COVID-19 infection among psoriasis patients was 0.03% (confidence interval [CI]: 0.01-0.06), with a pooled odds ratio of 1.97 (CI: 0.69-5.60) compared to the general population. The hospitalization rate, ICU admission rate, and case fatality rate for psoriasis patients with COVID-19 were 0.17 (CI: 0.10-0.31), 0.06 (CI: 0.06-0.46), and 0.02 (CI: 0.01-0.04), respectively. Additionally, psoriasis patients receiving systemic nonbiologic therapy had a pooled odds ratio of 2.32 (CI: 1.18-4.57) for hospitalization compared to those using biologic agents.
Studies have shown that biologic therapy for psoriasis did not increase the risk of hospitalization due to COVID-19 infection and may have even offered some protection. Treatment adherence was higher in psoriasis patients receiving biologic therapies than those receiving conventional therapies. These findings suggest that psoriasis treatment did not negatively impact COVID-19 infection and that treatment could be continued on a case-by-case basis during the pandemic.
本系统评价和荟萃分析旨在研究新型冠状病毒肺炎（COVID-19）与银屑病之间的相互影响，以为临床实践和未来研究提供参考。
我们遵循系统评价和荟萃分析的首选报告项目（PRISMA）方案进行系统评价，并检索了PubMed、科学网、Scopus和谷歌学术，检索截止至2022年5月1日。纳入标准包括以英文发表的关于银屑病患者COVID-19治疗结果的全文文章。排除动物研究、给编辑的信件、非英文研究以及无法获取全文的研究。由两组评审员对检索结果进行筛选并提取数据，如有任何差异由资深作者解决。使用ROBINS-I对非随机研究进行偏倚风险评估。提取银屑病患者的住院率、重症监护病房（ICU）入住率、病死率、COVID-19感染比值比和住院率，并采用随机效应分析进行分析，以计算合并患病率和比值比，并探索异质性。
我们从四个数据库中找到了1980条记录，经筛选和去除重复项后纳入了20项研究。这些研究评估了185,000例银屑病患者，包括八项回顾性队列研究、一项病例对照研究、三项横断面研究和八项病例系列研究。评估了COVID-19大流行对银屑病治疗的影响以及接受不同形式治疗的银屑病患者中COVID-19感染的结果。纳入研究的汇总数据显示，银屑病患者中COVID-19感染的发生率为0.03%（置信区间[CI]：0.01-0.06），与普通人群相比，合并比值比为1.97（CI：0.69-5.60）。COVID-19银屑病患者的住院率、ICU入住率和病死率分别为0.17（CI：0.10-0.31）、0.06（CI：0.06-0.46）和0.02（CI：0.01-0.04）。此外，与使用生物制剂的患者相比，接受全身性非生物治疗的银屑病患者住院的合并比值比为2.32（CI：1.18-4.57）。
研究表明，银屑病的生物治疗不会增加因COVID-19感染而住院的风险，甚至可能提供一些保护。接受生物治疗方案的银屑病患者的治疗依从性高于接受传统治疗方案的患者。这些发现表明，银屑病治疗不会对COVID-19感染产生负面影响，在大流行期间可根据具体情况继续治疗。
