Evaluating the Association Between Systemic Treatments for Moderate to Severe Psoriasis and SARS-CoV-2 Infection Outcomes

Abstract

Moderate to severe psoriasis is often treated with systemic medications, including traditional therapies (eg, methotrexate, cyclosporine) and biologics (eg, TNF inhibitors, IL-17 and IL-23 inhibitors). These immunomodulating treatments raise concerns about infection risks, particularly during the SARS-CoV-2 pandemic. However, literature on systemic therapy and COVID-19 outcomes in the United States is limited. This retrospective cohort study analyzed adults with psoriasis and a primary SARS-CoV-2 diagnosis from the 2020 Health care Cost and Utilization Project National Inpatient Sample database. Patients were stratified by systemic medication use, and propensity score matching adjusted for baseline comorbidities. Logistic regression and bivariate analyses assessed the association between systemic therapy and clinical outcomes, including medications and procedures for COVID-19 treatment, length of stay, and mortality. 721,870 patients were included after propensity score matching. Patients receiving systemic medications had higher odds of requiring supplemental oxygen (OR = 1.30; P < .001) but lower odds of mechanical ventilation (OR = .76; P < .001) and intubation (OR = .78; P < .001). They also experienced shorter hospital stays (IRR = .982; P < .001) and lower mortality (OR = .74; P < .001). Systemic treatments for psoriasis influence COVID-19 outcomes, reducing the need for severe respiratory interventions, shortening hospitalization duration, and lowering mortality. These findings highlight the safety of systemic therapies, even during periods of heightened infection risk like the SARS-CoV-2 pandemic. Future research should investigate the differential effects of biologics and traditional therapies.