34223 Incidence and prognosis of COVID-19 in patients with psoriasis on apremilast: A multicenter retrospective cohort study

Abstract

Exacerbated systemic signs/symptoms with a SARS-CoV-2 infection (COVID-19) have been linked to a disruption in the balance of pro- and anti-inflammatory cytokines. Investigations continue to determine how immunomodulatory therapies used for immune-mediated inflammatory diseases impact the clinical course of COVID-19. Accordingly, we aimed to quantify the proportion of patients with psoriasis who contracted COVID-19 during treatment with apremilast, an immunomodulatory treatment. Upon approval by the Research Ethics Board, this multicenter retrospective study was undertaken at 5 academic and 5 community dermatology practices in Canada. Inclusion criteria were patients ≥18 years of age with plaque or pustular psoriasis treated with apremilast. Data were collected between January 25, 2020 (1 documented COVID-19 case, zero deaths in Canada) and April 30, 2021 (1,211,083 cumulative COVID-19 cases, 24,169 deaths in Canada). Among the 402 identified patients receiving apremilast, there were no documented COVID-19 cases. These results demonstrate that apremilast use for psoriasis did not increase the risk of contracting SARS-CoV-2 infection compared with the general Canadian population (incidence of 3.2% as of April 30, 2021). Currently, there are no evidence-based guidelines to instruct clinicians on the use of apremilast during the COVID-19 pandemic. Our data suggest that discontinuation of apremilast treatment out of concern for contracting SARS-CoV-2 infection is not supported. In fact, cessation of therapy may lead to a flare of the condition being treated. Overall, apremilast does not increase susceptibility to SARS-CoV-2 infection in patients with psoriasis and can be considered a safe immunomodulatory therapy for this patient population during the pandemic.