As overall knowledge of the coronavirus disease (COVID-19) slowly develops into a clearer picture, dermatologists and researchers across the globe are working to connect the dots for certain patient groups. The American Academy of Dermatology’s COVID-19 Dermatology Registry seeks to outline both dermatologic presentation of COVID-19 or outcomes of patients with an existing dermatologic condition who then develop COVID-19.1 Surveillance Epidemiology of Coronavirus Under Research Exclusion (SECURE) for atopic dermatitis (AD) focuses on patients with AD and COVID-19,2 and SECURE-Alopecia similarly monitors outcomes of patients with alopecia areata and other alopecias.3
Psoriasis poses comparable management challenges as AD and alopecia during the modern pandemic. Dermatologists continue to field calls from patients regarding the safety of biologic therapy at this time and risk of severe infection with psoriasis as a preexisting condition. Thus, research groups across the globe are using provider-based registries to collect data to help guide the management of the patient with psoriasis and COVID-19 infection.
Domestic Research
In the United States, a number of groups are working to track the course and aftermath of COVID-19 in patients with psoriasis. The Corrona Psoriasis Registry is collecting information from a number of participating sites across the US and Canada. Nearly 600 dermatologists treating more than 7900 patients are already involved with the registry, which is gathering outcome measures such as Psoriasis Area and Severity Index, body surface area involvement, and Investigator Global Assessment along with a number of patient-reported outcomes. The National Psoriasis Foundation (NPF) is a longtime partner with the registry’s sponsoring research firm, Corrona. The registry is available at www.corrona.org/registry/psoriasis.
Another research group out of Wake Forest School of Medicine in Winston-Salem, NC, also hopes to improve understanding of how COVID-19 affects the outcomes of patient with psoriasis. SECURE-Psoriasis is headed by Steven R. Feldman, MD, PhD; William W. Huang, MD, MPH; Esther A. Balogh, MD; and Courtney Heron, BS, of the Center for Dermatology Research in the department of dermatology at Wake Forest. The group seeks to define the impact of COVID-19 on patients with psoriasis and determine how certain factors (eg, age, gender, comorbidities, and psoriasis treatments and severity) can impact outcomes. The NPF is also an official partner.
“As dermatologists know, many patients with psoriasis use systemic therapies to manage their disease. Many of these therapies have the potential to be immunomodulatory or even in some cases immunosuppressive,” said Dr Balogh. “So, we hope as we gather data about patients using these therapies, we can see which therapies are associated with better or worse outcomes during the pandemic.”
Dr Balogh explained that the SECURE-Psoriasis team wanted to make the registry (available at www.covidpso.org) simple for providers to participate. She emphasized that the data input should take approximately 5 minutes to complete and that clinicians who have provided care for a patient with psoriasis and COVID-19, regardless of country of origin, are encouraged to contribute. With a de-identified data collection, no identifying patient information is recorded for the study.
“Clinicians should note that we only accept [polymerase chain reaction] confirmed cases, not suspected cases, as the data needs to be as accurate as possible to best guide patient care. We also ask that participants wait a sufficient amount of time to monitor the disease course, such as the resolution of the acute illness or unfortunately, in some cases, death, to increase our understanding of potential risk factors in this special patient group,” said Dr Balogh.
The data analysis, while still somewhat in the future as cases continue to be collected, will be critical to tackling evidence-based guidelines. “We plan to stratify the cases by patient characteristics such as age and gender. We also want to analyze psoriatic characteristics, including diagnosis, subtype, and severity as based on the Physician Global Assessment Score. Lastly, as patients with psoriasis may be predisposed to a number of comorbidities, we want to see how these characteristics can influence the course of infection.”
International Collaboration
Dr Balogh noted that SECURE-Psoriasis is not alone in this mission. “We are planning to pool and share data with PsoProtect, and we hope that with a larger sample size, we will have more accurate observations.”
The PsoProtect Registry (officially titled Psoriasis Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection) is an international collaboration between clinicians, scientists, epidemiologists, and patient representatives that was rapidly established during the pandemic, with the aim of gathering observational data on COVID-19 outcomes in patients with psoriasis on a global scale. Its executive committee includes Dr Satveer Mahil, Professor Chris Griffiths, Professor Jonathan Barker, and Professor Catherine Smith, and the scientific study team hails from St John’s Institute of Dermatology, London (UK), and the Dermatology Centre at University of Manchester (UK).
“PsoProtect is a global initiative that seeks to better understand the underlying determinants of the outcome of COVID-19 and how this translates to individuals with the common inflammatory skin condition psoriasis,” said Dr Mahil. “We hope that this information will help inform assessments of risk of COVID-19 in individuals with psoriasis and guide clinical decision-making around their treatments.”
In a similar fashion to SECURE-Psoriasis, PsoProtect collects data through an easily accessible web-based case report form (available at www.psoprotect.org). Clinicians from all over the world should enter data once their patient with psoriasis has had COVID-19, whether confirmed or suspected, for a long enough duration for the individual to have an outcome (eg, death, partial recovery, complete recovery). Only de-identified data is collected, and the case report form takes approximately 5 to 10 minutes to complete.
Notably, the PsoProtect team have also launched a patient-facing survey called PsoProtectMe. “Patient-reported outcomes of COVID-19, patient experiences, and health behaviors during the pandemic are also key considerations for informing clinical care,” explained Dr Mahil. “We therefore also established PsoProtectMe, which is a self-report survey for all individuals with psoriasis worldwide, whether or not they have had COVID-19. We encourage all dermatologists to inform their patients of PsoProtectMe so that they can share their experiences of the pandemic.” The PsoProtectMe survey is available at www.psoprotectme.org.
The Data Thus Far
Data released thus far by both SECURE-Psoriasis and PsoProtect are limited, but both registries have updated their websites to include data for review. The websites note that any data is preliminary and should not be used to inform clinician decision-making.
“Since our registry is still in the early phases with a relatively small number of patients who have been reported so far, it might be a little premature to note defining trends such as characteristics associated with certain outcomes. But we definitely have interesting results despite a small sample size,” said Dr Balogh. “Our data has come predominantly from the United States, and we have a wide range of ages reported, from 32 years to as old as 90 years, but most of the patients who have been reported so far are men.”
Dr Balogh described that many of the patients presented with common comorbidities, including cardiovascular disease and diabetes, and that a variety of psoriasis therapies have been reported.4
The PsoProtect website features a summary of PsoProtect’s first 200 cases of COVID-19 in psoriasis.5 “We are currently undertaking our first in-depth analysis of the whole cohort, so we look forward to share these findings very soon,” said Dr Mahil.
References
1. COVID-19 dermatology registry. American Academy of Dermatology. Accessed May 29, 2020. https://www.aad.org/member/practice/coronavirus/registry
2. Coronavirus & atopic dermatitis reporting database. SECURE-AD Registry. Accessed May 29, 2020. https://www.covidderm.org/login/?next=/insight/
3. Coronavirus & alopecia reporting database. SECURE-Alopecia Registry. Accessed May 29, 2020. https://securealopecia.covidderm.org/login/?next=/insight/
4. Balogh EA, Heron CE, Feldman SR, Huang WW. SECURE-Psoriasis database public data update. Accessed May 29, 2020. https://www.covidpso.org
5. An overview of PsoProtect’s current data. PsoProtect. Accessed May 29, 2020. https://psoprotect.org/current-data/
