Methotrexate use associated with COVID-19 hospitalization in patients with psoriasis
COVID-19-associated hospitalization was more common in patients who were taking oral methotrexate but not in those taking biologics, according to a study.
“The medical society struggles with major uncertainty regarding the optimal method to manage patients with immune-mediated diseases necessitating systemic drugs during the COVID-19 pandemic,” Khalaf Kridin, MD, PhD, of Lübeck Institute of Experimental Dermatology, University of Lübeck, Germany, and colleagues wrote. “As immunosuppressive therapy can interfere with antiviral immunity, patients undergoing immunomodulatory treatment, particularly those with severe comorbidities, may be hypothetically more susceptible to worse outcomes of COVID-19.”
This population-based nested case-control study used the Clalit Health Services computerized database to identity 3,151 patients with psoriasis who tested positive for COVID-19.
Of these, 332 (10.5%) were hospitalized due to COVID-19, with 51 (1.6%) dying of the disease.
Using multivariable logistic regression, the researchers estimated odds ratios and 95% confidence intervals of COVID-19-associated hospitalization and mortality predictors.
Methotrexate use predicted hospitalization with an adjusted odds ratio of 2.30 (95% CI, 1.11-4.78; P = .025), while biologic drug use had an odds ratio of 0.75 (95% CI, 0.32-1.73). Mortality was also not associated with biologic use (OR = 0.85; 95% CI, 0.12-6.21).
Hospitalization and mortality were predicted by older age (OR = 11.23; 95% CI, 1.43-88.7339; P = .022), cardiovascular diseases (adjusted OR = 3.64; 95% CI, 1.77-7.50; P < .001), metabolic syndrome (adjusted OR = 2.90; 95% CI, 1.36-6.18; P = 0.006), chronic obstructive pulmonary disease (COPD) (adjusted OR = 2.24; 95% CI, 1.02-4.90; P = 0.029) and chronic renal failure (CRF) (adjusted OR = 3.47; 95% CI, 1.74-6.93; P < .001).
“The intake of oral systemic immunosuppressive agents, but not biologics, at the onset of the pandemic predisposes patients with psoriasis to COVID-19-associated hospitalization. Older age, comorbid cardiovascular diseases, metabolic syndrome, COPD and CRF independently predict COVID-19-associated hospitalization and mortality,” the authors wrote. “The administration of immunosuppressive agents should be weighed with caution during the pandemic. Patients with psoriasis with comorbid cardiovascular diseases, metabolic syndrome, COPD and CRF should be monitored closely.”