Lihi Eder, MD, PhD, on Assessing the Effectiveness of COVID-19 Vaccines Among Patients With Psoriatic Disease
A population-based study of 128,754 patients with psoriasis and/or psoriatic arthritis and 600,439 controls demonstrated that vaccines against SARS-CoV2 infection were similarly effective among both cohorts, according to a poster presentation by Lihi Eder, MD, at the American College of Rheumatology Convergence on November 12.
Dr Eder is director of the Psoriatic Arthritis Program at the Women’s College Hospital, an associate professor in the Division of Rheumatology, and director of research in the Rheumatology Division at the University of Toronto in Toronto, Ontario, Canada.
She and colleagues used data from the Clalit Health Services in Israel for their research. “We assessed the effectiveness of COVID-19 vaccinations in preventing infection and COVID-related hospitalizations in patients with psoriatic disease and nonpsoriatic controls, and also assessed the association of immune-mediated medications on these COVID-related outcomes,” Dr Eder explained.
The researchers assembled a cohort of patients with diagnoses of psoriasis and/or psoriatic arthritis—collectively termed psoriatic disease (PsD)— and matched them by age, sex, and clinic at a 1:5 ratio with nonpsoriatic controls. Data from 2 periods, December 2020-August 2021 (Period 1) and August 2021-December 2021 (Period 2). Period 1 corresponds to the initiation of COVID-19 vaccinations through the initiation of booster vaccines; Period 2 corresponds to initiation of booster vaccines to the end of the study.
Study outcomes included rates of SARS-CoV2 PCR positivity and hospitalization for COVID-19. Vaccine effectiveness was assessed using regression models with time varying covariates for vaccination status adjusted for demographics, comorbidities, and medication use.
Of a total of 128,754 patients with PsD and 600,439 controls (5,934 vs. 26,292 positive SARS-CoV2; 315 vs. 1,127 hospitalized, respectively). Vaccine effectiveness for SARS-CoV2 infection was similar among patients with PsD and controls (HR for 2nd vaccine: 0.20 vs. 0.20, respectively). Vaccine effectiveness for COVID-19 hospitalization was also similar among PsD patients and controls (HR for 2nd vaccine: 0.15 vs. 0.08, respectively; Figure 2A). Booster vaccines remained effective in reducing risk of infections (HRs for of 3rd vaccine: 0.41) and hospitalization (HR for of 3rd vaccine < 0.01) among patients with PsD. When the analysis was restricted to patients with PsD and adjusted for use of systemic therapies, vaccines remained effective for SARS-CoV2 infections (OR period 1: 2nd vaccine: 0.19; OR period 2: 3rd vaccine: < 0.01; Figure 1B) and hospitalizations (OR period 1: 2nd vaccine: 0.01; OR period 2: 3rd vaccine: 0.17; Figure 2B). Use of etanercept was associated with higher risk of SARS-CoV2 infection and JAK inhibitors use was associated with higher risk of hospitalizations (Table 1). PsA status was not associated with higher risk of both outcomes compared to patients with psoriasis alone.
For assessment of the association of medications and COVID-19-related outcomes, we performed a matched nested case-control study within the PsD cohort in which each case (SARS-CoV2 infection and COVID-19 hospitalization) was matched with 10 controls (negative for these outcomes).
The COVID-19 vaccine has similar effectiveness in patients with PsD to that seen in nonpsoriatic controls. Risk of COVID-19 hospitalization among PsD patients may be influenced by certain immune modulating therapies.
Reference:
Eder L, Lavi I, Haddad A, et al. Poster presentation 0389. Vaccine effectiveness among patients with psoriatic disease: A population-based study. Presented at: American College of Rheumatology Convergence. November 12, 2022.
