Tumor necrosis factor inhibitors are associated with a decreased risk of COVID‐19‐associated hospitalization in patients with psoriasis—A population‐based cohort study

Kridin, Khalaf; Schonmann, Yochai; Damiani, Giovanni; Peretz, Avi; Onn, Erez; Bitan, Dana Tzur; Cohen, Arnon D.

The risk of coronavirus disease 2019 (COVID‐19) and its complications among patients with psoriasis treated by tumor necrosis factor inhibitors (TNFis) remains to be decisively delineated. We aimed to assess the risk of COVID‐19 infection, COVID‐19‐associated hospitalization, and mortality among Israeli patients with psoriasis treated by TNFi relative to other systemic agents. A population‐based cohort study was conducted to compare psoriasis patients treated by TNFi (n = 1943), with those treated by methotrexate (n = 1929), ustekinumab (n = 348), and acitretin (n = 1892) regarding COVID‐19 outcomes. Risk of investigated outcomes was assessed using uni‐ and multi‐variate Cox regression analyses. The incidence rate of COVID‐19, COVID‐19‐associated hospitalization, and mortality in the TNFi group was 35.8 (95% CI, 26.1‐47.9), 0.8 (95% CI, 0.0‐4.2), and 0.0 per 1000 person‐years, respectively. Exposure to TNFi was associated with a comparable risk of COVID‐19 infection [adjusted hazard ration (HR) for TNFi vs methotrexate: 1.07 (95% CI, 0.67‐1.71); TNFi vs ustekinumab: 1.07 (95% CI, 0.48‐2.40); TNFi vs acitretin: 0.98 (95% CI, 0.61‐1.57)]. TNFi was associated with a decreased risk of COVID‐19‐associated hospitalization relative to methotrexate (adjusted HR, 0.10; 95% CI, 0.01‐0.82) and ustekinumab (adjusted HR, 0.04; 95% CI, 0.00‐0.64), but not to acitretin (adjusted HR, 1.00; 95% CI, 0.16‐6.16). No significant difference in COVID‐19‐associated mortality was found between the four different groups. TNFi was associated with a decreased risk of admissions due to COVID‐19. Our findings substantiate the continuation of TNFi treatment during the pandemic. TNFi may be positively considered in patients with moderate‐to‐severe psoriasis warranting systemic treatment during the pandemic.