Psoriasis Patients on Biologics May Have Better COVID-19 Outcomes, Study Finds

COVID-19 patients with psoriasis who take immunosuppressants for their condition are less likely to be hospitalized for the disease, according to a new study.

Data obtained from clinicians in 25 countries showed that patients who were receiving a biologic for their psoriasis were more likely to avoid hospitalization for COVID-19 than those who did not take the drugs. Biologics are protein-based medications that work by blocking specific elements of the immune system, and are often given by injection. 

The data was collected by registry PsoProtect and the study was led by researchers at the U.K.'s Guy's and St Thomas' NHS Foundation Trust.

Catherine Smith is a consultant dermatologist at St John's Institute of Dermatology, King's College London and Guy's and St Thomas' Hospital and a co-author of the study. She tells Verywell that while the connection between biologics and lower risk of COVID-19-related hospitalization is interesting, researchers don't know if the link is causal, or if the lower risk is directly due to use of biologics.

"There may be some other factor that is associated with taking a biologic drug—for example, social distancing—that is contributing to the reduced risk," Smith says.

"It could also be that the population of patients in the registry is not representative of the whole population with psoriasis that is taking drugs that affect the immune system."

After analyzing data of 374 patients, researchers found that 71% were on a biologic, 18% a non-biologic, and 10% reported no systemic treatment for their psoriasis. Out of these COVID-19 patients with psoriasis, 93% fully recovered from COVID-19. 

Twenty-one percent were hospitalized and 2% died, the study found. Patients who were older, male, or non-white were at greater risk of hospitalization—risk factors that are fairly consistent among COVID-19 patients.

"Hospitalization was more frequent in patients using non-biologic systemic therapy than biologics," researchers wrote. "No significant differences were found between biologic classes."

Smith says that further research is needed before concluding that biologics are safer than non-biologics in the context of COVID-19.

Why Biologics May Affect COVID-19 Patients 

Some people with moderate to severe psoriasis take biologics for their condition. Psoriasis is an autoimmune disorder that causes inflammation in the body and causes skin cells to turn over at an abnormally fast rate. This presents itself as plaques (or rashes or lesions) on the body. Psoriasis is not contagious.

To treat moderate to severe psoriasis, biologics can be helpful. Biologics are made from proteins that are either similar to or the same as proteins in the body’s immune system, and are often injected. The goal of a biologic is to block the immune system cells responsible for inflammation, and in turn, stop the skin reactions. 

"Currently, there are biologics that target three specific cytokines that cause inflammation in psoriasis, TNF, IL23, and IL17," Joel Gelfand, MD, a member of the National Psoriasis Foundation (NPF) Scientific Advisory Committee and professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania, tells Verywell.

"Depending on which cytokine is targeted, about six to nine out of 10 patients can expect to achieve clear or almost clear skin, which is remarkably effective."

One possible reason why researchers think biologics may impact COVID-19 is because they might affect "cytokine storm"—an immune response that can occur in serious cases. Cytokine storms are essentially an overreaction of the immune system that can be triggered by infection, as seen in severe COVID-19 cases. 

"There is consistent evidence that cytokines that are targeted by psoriasis treatments are elevated in patients who have bad outcomes from COVID," Gelfand, who is also co-chair of the NPF COVID-19 Task Force, says. "It is a working hypothesis that biologics that target certain cytokines, particularly TNF but also possibly IL17, may prevent progression to cytokine storm."

"Biologics that target these cytokines, which we routinely use for psoriasis and psoriatic arthritis, are in clinical trials in COVID patients to see if they can control the over active immune response some patients experience and prevent progression of COVID illness."

Still, Gelfand says that since the study is a collection of international case reports, the findings should be "interpreted cautiously." More research needs to be done.

The study's researchers even concluded that "it is unclear whether individuals with psoriasis are at greater risk of progression to this [cytokine storm] phase and conversely, whether immunosuppressants are effective therapies for severe COVID-19."

"The best we can say is that existing data generally suggest that treatments for psoriasis and/or psoriatic arthritis do not meaningfully alter the risk of acquiring SARS-CoV-2 infection or having worse COVID-19 outcomes," Gelfand, who consulted on the study, says.

Are certain biologics more effective when it comes to COVID-19 hospitalization?

Based on her team's research, Smith says they did not find any significant differences between the different classes of biologics drugs and hospitalization for COVID-19.

"However, the number of patients receiving different classes of biologics in the current analysis was limited, so we were not adequately powered to address this question," she adds.

Gelfand says for people with psoriasis, existing data suggests that generally speaking, patients with psoriasis and/or psoriatic arthritis have similar rates of COVID-19 infection and outcomes as the general population.

If a patient with psoriasis contracts COVID-19, Gelfand says it's best to speak to their doctor about their biologics, if they are on any.

"Based on limited available data, and to be consistent with FDA recommendations, it may be prudent to hold treatments that target the immune system in the setting of suspected or confirmed SARS-CoV-2 infection, but the final decision needs to be determined on a case by case basis," he says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.