Understanding views of patients on biologics for psoriasis amid the COVID‐19 pandemic – Pandher – – Journal of the European Academy of Dermatology and Venereology

Biologics target and inhibit specific cytokines, thereby suppressing the immune system and manifestation of psoriasis. Currently, there exist limited data on the impact of biologics on the coronavirus disease of 2019 (C19). The public may obtain information from many sources which may affect their understanding of biologic use during this pandemic. This study assessed psoriasis patients’ understanding of the safety of biologic use during the C19 pandemic and their perception of various information sources. We recruited 1104 participants to complete a REDCap survey (survey script is available on request from authors) though Amazon Mechanical Turk, and 281 of these participants fulfilled the following inclusion criteria: diagnosis of psoriasis, age ≥18 years and biologic use for psoriasis. Participants’ understanding of biologic use during the C19 pandemic was assessed using a five‐point scale, with one demonstrating no understanding and five advanced understanding. This scale was also used to assess their understanding of biologics’ effects on C19 outcomes, with one demonstrating increased chance of worse outcomes, and five of better outcomes. Additionally, participants were queried about sources they used to learn about this topic, sociodemographic characteristics and familiarity with medical terminology (Table 1). Descriptive statistics and linear regression were used to analyse data.

Of the 1104 respondents, 738 (69.4%) reported they did not have psoriasis, while 325 (30.5%) reported they did. Of these 325 participants, 281 indicated receiving treatment with at least one of the following biologics: certolizumab, secukinumab, etanercept, adalimumab, tildrakizumab‐asmn, abatacept, infliximab, brodalumab, golimumab, risankizumab‐rzaa, ustekinumab, ixekizumab, guselkumab. Seventeen participants chose ‘other’ but did not identify a known biologic in their ‘other’ response and their survey data were subsequently excluded. Twenty‐seven psoriasis patients were also excluded for reportedly not taking a biologic medication. On average, participants reported a moderate understanding of the risks and benefits of biologic use for psoriasis during the C19 pandemic (mean 2.95 ± 1.01, Table 1). On average, participants believed biologics neither increased nor decreased risk of experiencing worse outcomes from C19 (2.76 ± 1.02). Most participants stated they would stop their biologic or reduce dosage during the C19 pandemic (n = 160, 56.9% and 160, 56.9%, respectively). Participants most often reported family and friends as their source of information for understanding safety of biologics use during the pandemic (n = 145, 51.6%, Table 2). Dermatologists were the second most reportedly used source (n = 133, 47.3%) but reportedly the most accurate (n = 76, 27%). Social media were moderately used (n = 93, 33.1%). There was no association between demographics and reported understanding of biologic use during the pandemic. There was also no association between reported familiarity with medical terminology and perceived most accurate source.

The C19 pandemic has incited considerable worry among individuals taking immunosuppressive agents. Per our study, many participants believe stopping or reducing dosage of their biologic was the appropriate next step during this pandemic. Considering the wide‐reaching effects of uncontrolled psoriasis – psychosocial comorbidities, cardiovascular comorbidities, diminished quality of life – stopping biologic use or reducing dosage may be counterproductive and impact treatment efficacy.^1–3 Additionally, with the panoply of information sources comes risk of incongruous information. Fortunately, physicians have the highest likelihood of being considered the most accurate source, yet many patients still turn to other sources besides their physicians. With lack of peer review in social media and increasing publicity of preprint studies in the news, there is potential for spread of misinformation. Thus, there is a need for dispersal of better, more synchronous information on biologic use during the C19 pandemic that perhaps leans on physician‐vetted, peer‐reviewed, published recommendations.

Conflict of interest

Dr. Steven Feldman has received research, speaking and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Boehringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Abbvie, Samsung, Janssen, Lilly, Menlo, Merck, Novartis, Regeneron, Sanofi, Novan, Qurient, National Biological Corporation, Caremark, Advance Medical, Sun Pharma, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. He is founder and majority owner of www.DrScore.com and founder and part owner of Causa Research, a company dedicated to enhancing patients’ adherence to treatment. Mr. Pandher, Dr. Patel, Dr. Porter, and Dr. Huang have no conflicts to disclose.

Funding source

This article has no funding source.