O01: The impact of the COVID-19 pandemic on people with psoriasis: findings from a global patient-reported registry

S. Mahil,¹ M. Yates,² Z. Yiu,³ S. Langan,^1,4 T. Tsakok,¹ N. Dand,² K. Mason,⁵ H. McAteer,⁶ F. Meynell,¹ B. Coker,⁷ A. Vincent,⁷ D. Urmston,⁶ A. Vesty,⁶ J. Kelly,³ C. Lancelot,⁸ L. Moorhead,⁹ H. Bachelez,¹⁰ F. Capon,² C. Romina Contreras,¹¹ C. De La Cruz,¹² P. Di Meglio,² P. Gisondi,¹³ D. Jullien,¹⁴ J. Lambert,¹⁵ L. Naldi,¹⁶ S. Norton,¹⁷ L. Puig,¹⁸ P. Spuls,¹⁹ T. Torres,²⁰ R. Warren,³ H. Waweru,⁸ J. Weinman,²¹ C. Griffiths,³ J. Barker,²² M. Brown,⁷ J. Galloway²³ and C. Smith¹

¹St John’s Institute of Dermatology, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK; ²King’s College London, London, UK; ³Dermatology Centre, Salford Royal NHS Foundation Trust, The University of Manchester, Manchester, UK; ⁴Faculty of Epidemiology, and Population Health, London School of Hygiene and Tropical Medicine, London, UK; ⁵School of Medicine, Keele University, Keele, UK; ⁶The Psoriasis Association, Northampton, UK; ⁷NIHR Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK; ⁸International Federation of Psoriasis Associations, Bromma, Sweden; ⁹Guy's and St Thomas’ NHS Foundation Trust, London, UK; ¹⁰Department of Dermatology, AP-HP Hôpital Saint-Louis, Paris, France; ¹¹Catedra de Dermatologia, Hospital de Clinicas, Facultad de Ciencias Medicas, Universidad Nacional de Asuncion, Paraguay; ¹²Clinica Dermacross, Santiago, Chile; ¹³Section of Dermatology and Venereology, University of Verona, Verona, Italy; ¹⁴Department of Dermatology, Edouard Herriot Hospital, Hospices Civils de Lyon, University of Lyon, Lyon, France; ¹⁵Department of Dermatology, Ghent University, Ghent, Belgium; ¹⁶Centro Studi GISED, Bergamo, Italy; ¹⁷Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK; ¹⁸Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain; ¹⁹Department of Dermatology, Amsterdam Public Health/Infection and Immunology, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands; ²⁰Department of Dermatology, Centro Hospitalar do Porto, Portugal, Portugal; ²¹School of Cancer and Pharmaceutical Sciences, King’s College London, London, UK; ²²St John’s Institute of Dermatology, School of Basic and Medical Biosciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK; and ²³Centre for Rheumatic Diseases, King’s College London, London, UK

S.M. and M.Y. are joint first authors.

The COVID-19 pandemic has led to uncertainty over immunosuppressant-related infection risks, shortfalls in the care of long-term conditions and increased psychiatric illness. People with psoriasis may be particularly vulnerable to the negative effects of the pandemic owing to prevalent physical and psychiatric multimorbidity, and the need for systemic immunosuppressants in moderate-to-severe disease. This study sought to assess the course of psoriasis in the pandemic and characterize the factors associated with worsening disease. Individuals with clinician-confirmed psoriasis completed the online global self-report registry Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection Me (PsoProtectMe), up to 7 September 2020. Participants specified if their psoriasis had worsened, improved or remained the same in the pandemic. Each participant completed validated self-report screens for depression (Patient Health Questionnaire-2) or anxiety (Generalised Anxiety Disorder-2). Odds ratios (OR) and 95% confidence intervals (CI) for the association between worsening psoriasis and demographic and disease-specific factors were estimated using multivariable logistic regression. In total, 3049 people with psoriasis (and without confirmed/suspected COVID-19) from 72 countries self-reported to PsoProtectMe [mean age 47·0 (SD 15·1) years; mean body mass index 27·5 kg m^–2 (SD 6·0); 2003 (65·7%) patients were female; and 2396 (78·6%) were of white European ethnicity]. Altogether, 1219 (40·0%) participants reported worsening of their psoriasis in the pandemic. There was an inverse association between worsening psoriasis and male sex (OR 0·49, 95% CI 0·40–0·61). Worsening disease was associated with a positive screen for depression or anxiety [adjusted OR (aOR) 1·96, 95% CI 1·55–2·47], obesity (aOR 1·24, 95% CI 1·09–1·41), shielding/quarantine (aOR 1·26, 95% CI 1·08–1·47) and systemic therapy nonadherence (aOR 3·27, 95% CI 2·57–4·17). The most common reason for nonadherence was concern about complications related to COVID-19 (65·8%). These data suggest a substantial burden from worsening psoriasis in the pandemic. To mitigate potentially long-lasting effects of the pandemic on health outcomes in psoriasis, access to holistic care should be maintained, including psychological and weight-management support. Patient nonadherence to therapy may be addressed through evidence-based communication on treatment-related COVID-19 risks.