No Increased Risk of Severe COVID-19 Among Children With Psoriasis Using Biologics

For children with psoriasis, a study published in Journal of the European Academy of Dermatology and Venereology demonstrated that biologics were safe and not linked to an increased risk of severe COVID-19.

The authors of the study also found that, in some children, COVID-19 was responsible for the development or worsening of psoriasis.

“Viral and bacterial infections are a well-known possible trigger of psoriasis (either psoriasis de novo, of exacerbation of psoriasis), particularly guttate psoriasis in children,” the authors explained. “Likewise psoriasis may be exacerbated by SARS-CoV-2.”

To evaluate both the impact of COVID-19 on pediatric psoriasis and how systemic treatments may affect severity of the virus, the authors set up an international registry of children aged younger than 18 who had COVID-19, and have a history of psoriasis or developed it within 1 month of SARS-CoV-2 infection.

A total of 120 COVID-19 cases among 117 children from 14 countries were reported in the registry, with cases from 106 children confirmed. The mean age was 12.4 years and the main clinical form of psoriasis prior to SARS-CoV-2 infection was generalized plaque psoriasis (69.4%).

Of this group, 82 children had active psoriasis prior to infection and 26 were in remission.

Most children (54.2%) were not on systemic treatment at time of infection, while 33 (28.3%) were receiving biologic therapies and 24 (20.0%) were receiving non-biologic systemic drugs.

For the 75 children who were symptomatic, symptoms lasted a mean of 6.5 days. This duration was significantly longer for those receiving non-biologic systemic treatments (P = .02) and without systemic treatment (P = .006), compared with those receiving biologics.

Additionally, 6 children were hospitalized for COVID-19, with 1 being admitted to an intensive care unit. According to the authors, these children were more frequently receiving non-biologic systemic treatment compared with children in the other groups (P = .01) and particularly on methotrexate (P = .03).

After infection, psoriasis worsened in 17 cases (15.2%), with 9 (8.0%) children developing psoriasis within the next month, mainly in guttate form (P = .01).

According to the authors, there was no evidence of increased risk for severe COVID-19 among children receiving biologic therapies for their psoriasis. However, they noted that the small sample size, while international, was still a major limitation for statistical evaluation.

“It is not clear if biologic drugs have an actual protective effect on COVID-19 outcome, but data on their use during the pandemic support a non-harmful impact on the course of SARS-CoV-2 infection,” they said.

They also noted these results are consistent with past findings that viral and bacterial infections can trigger psoriasis.

“While discussing the initiation or continuation of a systemic treatment, both patients and their families need to be aware of the risk of a psoriasis flare-up in case of infection, and the impact of biologic drugs on the severity of the infection,” the authors concluded.

Reference

Zitouni J, Bursztejn AC, Belloni Fortina A, et al. Children with psoriasis and COVID-19: factors associated with an unfavourable COVID-19 course, and the impact of infection on disease progression (Chi-PsoCov registry). J Eur Acad Dermatol Venereol. Published online June 24, 2022. doi:10.1111/jdv.18361