076 Risk of severe COVID-19 associated with immune-modifying drugs: data from PsoProtect and Global Rheumatology Alliance registries

Abstract

The risk of adverse COVID-19 outcomes in people with IMIDs is poorly characterised, in part because analyses have been insufficiently powered to interrogate drug-specific risks associated with immune-modifying therapy. We pooled clinician-reported data from PsoProtect and Global Rheumatology Alliance (to 25/10/21) from IMID populations that share biology and therapies. We used ordinal multivariable logistic regression to assess associations between COVID-19 outcome (no hospitalisation/death; hospitalisation but no death; death) and immune-modifying drugs, adjusting for clinical/demographic factors. 5045 people with psoriasis alone (n=921), psoriatic arthritis (PsA, n=2293) and axial spondyloarthritis (n=1831) were included (mean age 50 [SD 13.5], 51.7% male). 16.4% were hospitalised and 1.8% died. Severe COVID-19 outcomes were associated with older age, male sex and comorbidities including obesity. Severe COVID-19 was associated with high disease activity and glucocorticoid intake compared to low disease activity without glucocorticoids (OR 2.23, 95%CI 1.39-3.58). A diagnosis of psoriasis alone (without arthritis) was associated with less severe COVID-19 outcomes compared with PsA (0.49, 0.37-0.65). Compared to no immune-modifying therapy, use of methotrexate (1.03, 0.76-1.40), JAK inhibitors (JAKi 1.58, 0.83-3.01) and apremilast (1.04, 0.57-1.91) was not associated with severe COVID-19 outcomes, and biologics use was associated with less severe COVID-19 outcomes (TNFi [0.57, 0.44-0.73], IL17i [0.62, 0.45-0.87], IL-23i [0.67, 0.45-0.98]). In a pooled population of people with psoriasis, PsA and axial spondyloarthritis, compared to no therapy, none of the immune-modifying drugs were associated with severe COVID-19 outcomes, and no important biologic-specific differences were identified. Our data suggest biologic choice should be driven by patient need and add further evidence to indicate adverse COVID-19 outcomes are associated with high disease activity, glucocorticoid use and comorbidity burden.