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2. 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)

Author

Zitouni, J., Bursztejn, A-C, Fortina, A. Belloni, Beauchet, A., Di Lernia, V, Lesiak, A., Thomas, J., Topkarci, Z., Murashkin, N., Brzezinski, P., Torres, T., Chiriac, A., Luca, C., McPherson, T., Akinde, M., Maruani, A., Epishev, R., de la Cruz, H. Vidaurri, Luna, P. C., de la Breteque, M. Amy, Lasek, A., Bourrat, E., Bachelerie, M., Mallet, S., Steff, M., Bellissen, A., Neri, I, Zafiriou, E., van den Reek, J. M. P. A., Sonkoly, Enikö, Mahil, S. K., Smith, C. H., Flohr, C., Bachelez, H., Mahe, E., Zitouni, J., Bursztejn, A-C, Fortina, A. Belloni, Beauchet, A., Di Lernia, V, Lesiak, A., Thomas, J., Topkarci, Z., Murashkin, N., Brzezinski, P., Torres, T., Chiriac, A., Luca, C., McPherson, T., Akinde, M., Maruani, A., Epishev, R., de la Cruz, H. Vidaurri, Luna, P. C., de la Breteque, M. Amy, Lasek, A., Bourrat, E., Bachelerie, M., Mallet, S., Steff, M., Bellissen, A., Neri, I, Zafiriou, E., van den Reek, J. M. P. A., Sonkoly, Enikö, Mahil, S. K., Smith, C. H., Flohr, C., Bachelez, H., and Mahe, E.

Abstract

Background The COVID-19 pandemic has raised questions regarding the management of chronic skin diseases, especially in patients on systemic treatments. Data concerning the use of biologics in adults with psoriasis are reassuring, but data specific to children are missing. Moreover, COVID-19 could impact the course of psoriasis in children. Objectives The aim of this study was therefore to assess the impact of COVID-19 on the psoriasis of children, and the severity of the infection in relation to systemic treatments. Methods We set up an international registry of paediatric psoriasis patients. Children were included if they were under 18 years of age, had a history of psoriasis, or developed it within 1 month of COVID-19 and had COVID-19 with or without symptoms. Results One hundred and twenty episodes of COVID-19 in 117 children (mean age: 12.4 years) were reported. The main clinical form of psoriasis was plaque type (69.4%). Most children were without systemic treatment (54.2%); 33 (28.3%) were on biologic therapies, and 24 (20%) on non-biologic systemic drugs. COVID-19 was confirmed in 106 children (88.3%) and 3 children had two COVID-19 infections each. COVID-19 was symptomatic for 75 children (62.5%) with a mean duration of 6.5 days, significantly longer for children on non-biologic systemic treatments (P = 0.02) and without systemic treatment (P = 0.006) when compared with children on biologics. The six children who required hospitalization were more frequently under non-biologic systemic treatment when compared with the other children (P = 0.01), and particularly under methotrexate (P = 0.03). After COVID-19, the psoriasis worsened in 17 cases (15.2%). Nine children (8%) developed a psoriasis in the month following COVID-19, mainly a guttate form (P = 0.01). Discussion Biologics appear to be safe with no increased risk of severe form of COVID-19 in children with psoriasis. COVID-19 was responsible for the development of psoriasis or the worsening of a known ps

Published
2022
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5. Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type : a cross-sectional patient survey

Author

Mahil, S. K., Yates, M., Langan, S. M., Yiu, Z. Z.N., Tsakok, T., Dand, N., Mason, K. J., McAteer, H., Meynell, F., Coker, B., Vincent, A., Urmston, D., Vesty, A., Kelly, J., Lancelot, C., Moorhead, L., Bachelez, H., Bruce, I. N., Capon, F., Contreras, C. R., Cope, A. P., De La Cruz, C., Di Meglio, P., Gisondi, P., Hyrich, K., Jullien, D., Lambert, J., Marzo-Ortega, H., McInnes, I., Naldi, L., Norton, S., Puig, L., Sengupta, R., Spuls, P., Torres, T., Warren, R. B., Waweru, H., Weinman, J., Griffiths, C. E.M., Barker, J. N., Brown, M. A., Galloway, J. B., Smith, C. H., other, and, Mahil, S. K., Yates, M., Langan, S. M., Yiu, Z. Z.N., Tsakok, T., Dand, N., Mason, K. J., McAteer, H., Meynell, F., Coker, B., Vincent, A., Urmston, D., Vesty, A., Kelly, J., Lancelot, C., Moorhead, L., Bachelez, H., Bruce, I. N., Capon, F., Contreras, C. R., Cope, A. P., De La Cruz, C., Di Meglio, P., Gisondi, P., Hyrich, K., Jullien, D., Lambert, J., Marzo-Ortega, H., McInnes, I., Naldi, L., Norton, S., Puig, L., Sengupta, R., Spuls, P., Torres, T., Warren, R. B., Waweru, H., Weinman, J., Griffiths, C. E.M., Barker, J. N., Brown, M. A., Galloway, J. B., Smith, C. H., and other, and

Abstract

Background: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments. Objectives: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation. Methods: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model. Results: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term ‘shielding’). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35–1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23–1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05–1·24), obesity (OR 1·37, 95% CI 1·23–1·54), comorbidity burden (OR 1·43, 95% CI 1·15–1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27–1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36–1·80). Modest differences in the proportion shielding were observed across nations. Conclusions: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contr

Published
2021

6. Describing the burden of the COVID-19 pandemic in people with psoriasis : findings from a global cross-sectional study

Author

Mahil, S. K., Yates, Mark, Yiu, Z. Z.N., Langan, S. M., Tsakok, T., Dand, N., Mason, Kayleigh J., McAteer, H., Meynell, F., Coker, B., Vincent, A., Urmston, D., Vesty, A., Kelly, J., Lancelot, C., Moorhead, L., Bachelez, H., Capon, F., Contreras, C. R., De La Cruz, C., Di Meglio, P., Gisondi, P., Jullien, D., Lambert, J., Naldi, L., Norton, S., Puig, L., Spuls, P., Torres, T., Warren, R. B., Waweru, H., Weinman, J., Brown, M. A., Galloway, J. B., Griffiths, C. M., Barker, J. N., Smith, C. H., other, and, Mahil, S. K., Yates, Mark, Yiu, Z. Z.N., Langan, S. M., Tsakok, T., Dand, N., Mason, Kayleigh J., McAteer, H., Meynell, F., Coker, B., Vincent, A., Urmston, D., Vesty, A., Kelly, J., Lancelot, C., Moorhead, L., Bachelez, H., Capon, F., Contreras, C. R., De La Cruz, C., Di Meglio, P., Gisondi, P., Jullien, D., Lambert, J., Naldi, L., Norton, S., Puig, L., Spuls, P., Torres, T., Warren, R. B., Waweru, H., Weinman, J., Brown, M. A., Galloway, J. B., Griffiths, C. M., Barker, J. N., Smith, C. H., and other, and

Published
2021

7. Factors associated with adverse COVID-19 outcomes in patients with psoriasis—insights from a global registry–based study

Author

Mahil, S, Dand, N, Mason, K, Yiu, Z, Tsakok, T, Meynell, F, Coker, B, Mcateer, H, Moorhead, L, Mackenzie, T, Rossi, M, Rivera, R, Mahe, E, Carugno, A, Magnano, M, Rech, G, Balogh, E, Feldman, S, De La Cruz, C, Choon, S, Naldi, L, Lambert, J, Spuls, P, Jullien, D, Bachelez, H, Mcmahon, D, Freeman, E, Gisondi, P, Puig, L, Warren, R, Di Meglio, P, Langan, S, Capon, F, Griffiths, C, Barker, J, Smith, C, Shah, A, Barea, A, Romero-Mate, A, Singapore, A, Paolino, A, Mwale, A, Morales Callaghan, A, Martinez, A, Decrescenzo, A, Pink, A, Jones, A, Sergeant, A, Essex, A, Bewley, A, Makrygeorgou, A, van Huizen, A, Perez-Suarez, B, Farida, B, Clareus, B, Prims, C, Davis, C, Quinlan, C, Maybury, C, Cesar, G, Barclay, C, Greco, C, Brassard, D, Cummings, D, Kolli, D, Descamps, V, Genao, D, Carras, E, Hawryluk, E, Martinez-Garcia, E, Klujszo, E, Dwyer, E, Toni, E, Sonkoly, E, Loayza, E, Dauden, E, Valenzuela, F, Popov, G, King, G, Celine, G, Aparicio, G, Johnston, G, Cardozo, G, Pearson, I, Yanguas, I, Weisman, J, Carolan, J, Hughes, J, Ortiz-Salvador, J, Carrascosa, J, Schwartz, J, Jackson, K, Kerisit, K, Wu, K, Asfour, L, de Graaf, L, Lesort, C, Meuleman, L, Eidsmo, L, Skov, L, Gribben, L, Rustin, M, Velasco, M, Panchal, M, Lakhan, M, Franco, M, Svensson, M, Vandaele, M, Marovt, M, Zargari, O, De Caso, P, Varela, P, Jenkin, P, Phan, C, Hampton, P, Goldsmith, P, Bak, R, Speeckaert, R, Romiti, R, Woolf, R, Mercado-Seda, R, Khatun, R, Ceovic, R, Taberner, R, Cohen, R, Stefanescu, S, Kirk, S, Reeken, S, Ayob, S, Perez-Barrio, S, Piaserico, S, Hoey, S, Torres, T, Talme, T, Desai, T, van Geest, A, King, V, Di Lernia, V, Koreja, Z, Hasab, V, Mahil S. K., Dand N., Mason K. J., Yiu Z. Z. N., Tsakok T., Meynell F., Coker B., McAteer H., Moorhead L., Mackenzie T., Rossi M. T., Rivera R., Mahe E., Carugno A., Magnano M., Rech G., Balogh E. A., Feldman S. R., De La Cruz C., Choon S. E., Naldi L., Lambert J., Spuls P., Jullien D., Bachelez H., McMahon D. E., Freeman E. E., Gisondi P., Puig L., Warren R. B., Di Meglio P., Langan S. M., Capon F., Griffiths C. E. M., Barker J. N., Smith C. H., Shah A., Barea A., Romero-Mate A., Singapore A., Paolino A., Mwale A., Morales Callaghan A. M., Martinez A., DeCrescenzo A., Pink A. E., Jones A., Sergeant A., Essex A., Bewley A., Makrygeorgou A., van Huizen A., Perez-Suarez B., Farida B., Clareus B. W., Prims C. T., Davis C., Quinlan C., Maybury C., Cesar G. A., Barclay C., Greco C., Brassard D., Cummings D., Kolli D., Descamps V., Genao D. R., Carras E., Hawryluk E., Martinez-Garcia E., Klujszo E., Dwyer E., Toni E., Sonkoly E., Loayza E., Dauden E., Valenzuela F., Popov G., King G., Celine G., Aparicio G., Johnston G. A., Cardozo G. A., Pearson I., Yanguas I., Weisman J., Carolan J. E., Hughes J., Ortiz-Salvador J. -M., Carrascosa J. -M., Schwartz J. J., Jackson K., Kerisit K. G., Wu K., Asfour L., de Graaf L., Lesort C., Meuleman L., Eidsmo L., Skov L., Gribben L., Rustin M., Velasco M., Panchal M., Lakhan M., Franco M. D., Svensson M. -L., Vandaele M., Marovt M., Zargari O., De Caso P., Varela P., Jenkin P., Phan C., Hampton P., Goldsmith P., Bak R., Speeckaert R., Romiti R., Woolf R., Mercado-Seda R., Khatun R., Ceovic R., Taberner R., Cohen R. W., Stefanescu S., Kirk S., Reeken S., Ayob S., Perez-Barrio S., Piaserico S., Hoey S., Torres T., Talme T., Desai T. V., van Geest A. J., King V., Di Lernia V., Koreja Z., Hasab V. Z., Mahil, S, Dand, N, Mason, K, Yiu, Z, Tsakok, T, Meynell, F, Coker, B, Mcateer, H, Moorhead, L, Mackenzie, T, Rossi, M, Rivera, R, Mahe, E, Carugno, A, Magnano, M, Rech, G, Balogh, E, Feldman, S, De La Cruz, C, Choon, S, Naldi, L, Lambert, J, Spuls, P, Jullien, D, Bachelez, H, Mcmahon, D, Freeman, E, Gisondi, P, Puig, L, Warren, R, Di Meglio, P, Langan, S, Capon, F, Griffiths, C, Barker, J, Smith, C, Shah, A, Barea, A, Romero-Mate, A, Singapore, A, Paolino, A, Mwale, A, Morales Callaghan, A, Martinez, A, Decrescenzo, A, Pink, A, Jones, A, Sergeant, A, Essex, A, Bewley, A, Makrygeorgou, A, van Huizen, A, Perez-Suarez, B, Farida, B, Clareus, B, Prims, C, Davis, C, Quinlan, C, Maybury, C, Cesar, G, Barclay, C, Greco, C, Brassard, D, Cummings, D, Kolli, D, Descamps, V, Genao, D, Carras, E, Hawryluk, E, Martinez-Garcia, E, Klujszo, E, Dwyer, E, Toni, E, Sonkoly, E, Loayza, E, Dauden, E, Valenzuela, F, Popov, G, King, G, Celine, G, Aparicio, G, Johnston, G, Cardozo, G, Pearson, I, Yanguas, I, Weisman, J, Carolan, J, Hughes, J, Ortiz-Salvador, J, Carrascosa, J, Schwartz, J, Jackson, K, Kerisit, K, Wu, K, Asfour, L, de Graaf, L, Lesort, C, Meuleman, L, Eidsmo, L, Skov, L, Gribben, L, Rustin, M, Velasco, M, Panchal, M, Lakhan, M, Franco, M, Svensson, M, Vandaele, M, Marovt, M, Zargari, O, De Caso, P, Varela, P, Jenkin, P, Phan, C, Hampton, P, Goldsmith, P, Bak, R, Speeckaert, R, Romiti, R, Woolf, R, Mercado-Seda, R, Khatun, R, Ceovic, R, Taberner, R, Cohen, R, Stefanescu, S, Kirk, S, Reeken, S, Ayob, S, Perez-Barrio, S, Piaserico, S, Hoey, S, Torres, T, Talme, T, Desai, T, van Geest, A, King, V, Di Lernia, V, Koreja, Z, Hasab, V, Mahil S. K., Dand N., Mason K. J., Yiu Z. Z. N., Tsakok T., Meynell F., Coker B., McAteer H., Moorhead L., Mackenzie T., Rossi M. T., Rivera R., Mahe E., Carugno A., Magnano M., Rech G., Balogh E. A., Feldman S. R., De La Cruz C., Choon S. E., Naldi L., Lambert J., Spuls P., Jullien D., Bachelez H., McMahon D. E., Freeman E. E., Gisondi P., Puig L., Warren R. B., Di Meglio P., Langan S. M., Capon F., Griffiths C. E. M., Barker J. N., Smith C. H., Shah A., Barea A., Romero-Mate A., Singapore A., Paolino A., Mwale A., Morales Callaghan A. M., Martinez A., DeCrescenzo A., Pink A. E., Jones A., Sergeant A., Essex A., Bewley A., Makrygeorgou A., van Huizen A., Perez-Suarez B., Farida B., Clareus B. W., Prims C. T., Davis C., Quinlan C., Maybury C., Cesar G. A., Barclay C., Greco C., Brassard D., Cummings D., Kolli D., Descamps V., Genao D. R., Carras E., Hawryluk E., Martinez-Garcia E., Klujszo E., Dwyer E., Toni E., Sonkoly E., Loayza E., Dauden E., Valenzuela F., Popov G., King G., Celine G., Aparicio G., Johnston G. A., Cardozo G. A., Pearson I., Yanguas I., Weisman J., Carolan J. E., Hughes J., Ortiz-Salvador J. -M., Carrascosa J. -M., Schwartz J. J., Jackson K., Kerisit K. G., Wu K., Asfour L., de Graaf L., Lesort C., Meuleman L., Eidsmo L., Skov L., Gribben L., Rustin M., Velasco M., Panchal M., Lakhan M., Franco M. D., Svensson M. -L., Vandaele M., Marovt M., Zargari O., De Caso P., Varela P., Jenkin P., Phan C., Hampton P., Goldsmith P., Bak R., Speeckaert R., Romiti R., Woolf R., Mercado-Seda R., Khatun R., Ceovic R., Taberner R., Cohen R. W., Stefanescu S., Kirk S., Reeken S., Ayob S., Perez-Barrio S., Piaserico S., Hoey S., Torres T., Talme T., Desai T. V., van Geest A. J., King V., Di Lernia V., Koreja Z., and Hasab V. Z.

Abstract

Background: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. Objective: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. Methods: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. Results: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite ethnicity (OR = 3.15; 95% CI = 1.24-8.03), and comorbid chronic lung disease (OR = 3.87; 95% CI = 1.52-9.83). Hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). Conclusion: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19–related hospitalization than with

Published
2021

15. Association Between Tumor Necrosis Factor Inhibitors and the Risk of Hospitalization or Death Among Patients With Immune-Mediated Inflammatory Disease and COVID-19

Author

Ryan C. Ungaro, Therapy Psoriasis Patient Registry for Outcomes, Leanna Wise, Hanns-Martin Lorenz, Pascal Claudepierre, Suleman Bhana, Michael D. Kappelman, Anja Strangfeld, Loreto Carmona, Wendy Costello, Eva Klingberg, Elsa F Mateus, Pedro Machado, Rosana Quintana, Jeffrey A. Sparks, Mark Yates, Zara Izadi, Erica J. Brenner, Nick Dand, Jean W. Liew, Bimba F. Hoyer, Gabriela Schmajuk, Alí Duarte-García, Carolina A. Isnardi, Saskia Lawson-Tovey, Kristin M. D’Silva, Patricia P. Katz, Manasi Agrawal, Jinoos Yazdany, Philippe Goupille, Zenas Z N Yiu, Zachary S. Wallace, Enrique R. Soriano, Catherine H. Smith, Ana Rita Cruz-Machado, Emily L Gilbert, Naomi J Patel, Maria O Valenzuela-Almada, Jonathan S. Hausmann, Christopher E.M. Griffiths, Giovanna Cuomo, Emily Sirotich, Stephanie Rush, Laura Trupin, Ana Carolina Mazeda Pereira, Xian Zhang, Kimme L. Hyrich, Jean-Frederic Colombel, René-Marc Flipo, Rebecca Hasseli, Alain Cantagrel, Satveer K. Mahil, Marta Caprioli, Andrea M Seet, Samar Al Emadi, Philip Robinson, Claudia Diniz Lopes Marques, Ricardo Machado Xavier, Rebecca Grainger, Tiffany Y-T Hsu, Lindsay Jacobsohn, Adriana Maria Kakehasi, Paul Sufka, Milena A. Gianfrancesco, Alexander Pfeil, Jonathan Barker, Izadi, Z., Brenner, E. J., Mahil, S. K., Dand, N., Yiu, Z. Z. N., Yates, M., Ungaro, R. C., Zhang, X., Agrawal, M., Colombel, J. -F., Gianfrancesco, M. A., Hyrich, K. L., Strangfeld, A., Carmona, L., Mateus, E. F., Lawson-Tovey, S., Klingberg, E., Cuomo, G., Caprioli, M., Cruz-Machado, A. R., Mazeda Pereira, A. C., Hasseli, R., Pfeil, A., Lorenz, H. -M., Hoyer, B. F., Trupin, L., Rush, S., Katz, P., Schmajuk, G., Jacobsohn, L., Seet, A. M., Al Emadi, S., Wise, L., Gilbert, E. L., Duarte-Garcia, A., Valenzuela-Almada, M. O., Isnardi, C. A., Quintana, R., Soriano, E. R., Hsu, T. Y. -T., D'Silva, K. M., Sparks, J. A., Patel, N. J., Xavier, R. M., Marques, C. D. L., Kakehasi, A. M., Flipo, R. -M., Claudepierre, P., Cantagrel, A., Goupille, P., Wallace, Z. S., Bhana, S., Costello, W., Grainger, R., Hausmann, J. S., Liew, J. W., Sirotich, E., Sufka, P., Robinson, P. C., Machado, P. M., Griffiths, C. E. M., Barker, J. N., Smith, C. H., Yazdany, J., Kappelman, M. D., APH - Methodology, APH - Quality of Care, AII - Inflammatory diseases, and Dermatology

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Azathioprine, Comorbidity, Lower risk, Inflammatory bowel disease, Arthritis, Rheumatoid, Internal medicine, Psoriasis, medicine, Humans, Registries, Pandemics, Retrospective Studies, Original Investigation, SARS-CoV-2, Tumor Necrosis Factor-alpha, business.industry, Research, COVID-19, Retrospective cohort study, General Medicine, Odds ratio, Middle Aged, Inflammatory Bowel Diseases, medicine.disease, TNF inhibitor, Hospitalization, Online Only, Infectious Diseases, Rheumatoid arthritis, Drug Therapy, Combination, Female, Tumor Necrosis Factor Inhibitors, business, medicine.drug
Abstract

Key Points Question Is receipt of tumor necrosis factor (TNF) inhibitor monotherapy at the time of COVID-19 diagnosis associated with adverse COVID-19 outcomes compared with other treatment regimens among patients with immune-mediated inflammatory diseases (IMIDs)? Findings In this cohort study of 6077 patients with IMIDs and COVID-19, TNF inhibitors in combination with azathioprine/6-mercaptopurine therapy, methotrexate monotherapy, azathioprine/6-mercaptopurine monotherapy, or Janus kinase inhibitor monotherapy were each associated with significantly higher odds of hospitalization or death compared with TNF inhibitor monotherapy. Meaning This study’s findings support the continued use of TNF inhibitor monotherapy among individuals with IMIDs during the pandemic., Importance Although tumor necrosis factor (TNF) inhibitors are widely prescribed globally because of their ability to ameliorate shared immune pathways across immune-mediated inflammatory diseases (IMIDs), the impact of COVID-19 among individuals with IMIDs who are receiving TNF inhibitors remains insufficiently understood. Objective To examine the association between the receipt of TNF inhibitor monotherapy and the risk of COVID-19–associated hospitalization or death compared with other commonly prescribed immunomodulatory treatment regimens among adult patients with IMIDs. Design, Setting, and Participants This cohort study was a pooled analysis of data from 3 international COVID-19 registries comprising individuals with rheumatic diseases, inflammatory bowel disease, and psoriasis from March 12, 2020, to February 1, 2021. Clinicians directly reported COVID-19 outcomes as well as demographic and clinical characteristics of individuals with IMIDs and confirmed or suspected COVID-19 using online data entry portals. Adults (age ≥18 years) with a diagnosis of inflammatory arthritis, inflammatory bowel disease, or psoriasis were included. Exposures Treatment exposure categories included TNF inhibitor monotherapy (reference treatment), TNF inhibitors in combination with methotrexate therapy, TNF inhibitors in combination with azathioprine/6-mercaptopurine therapy, methotrexate monotherapy, azathioprine/6-mercaptopurine monotherapy, and Janus kinase (Jak) inhibitor monotherapy. Main Outcomes and Measures The main outcome was COVID-19–associated hospitalization or death. Registry-level analyses and a pooled analysis of data across the 3 registries were conducted using multilevel multivariable logistic regression models, adjusting for demographic and clinical characteristics and accounting for country, calendar month, and registry-level correlations. Results A total of 6077 patients from 74 countries were included in the analyses; of those, 3215 individuals (52.9%) were from Europe, 3563 individuals (58.6%) were female, and the mean (SD) age was 48.8 (16.5) years. The most common IMID diagnoses were rheumatoid arthritis (2146 patients [35.3%]) and Crohn disease (1537 patients [25.3%]). A total of 1297 patients (21.3%) were hospitalized, and 189 patients (3.1%) died. In the pooled analysis, compared with patients who received TNF inhibitor monotherapy, higher odds of hospitalization or death were observed among those who received a TNF inhibitor in combination with azathioprine/6-mercaptopurine therapy (odds ratio [OR], 1.74; 95% CI, 1.17-2.58; P = .006), azathioprine/6-mercaptopurine monotherapy (OR, 1.84; 95% CI, 1.30-2.61; P = .001), methotrexate monotherapy (OR, 2.00; 95% CI, 1.57-2.56; P, This cohort study uses data from 3 international registries to examine the association between the receipt of tumor necrosis factor monotherapy and the risk of COVID-19–associated hospitalization or death among adult patients with immune-mediated inflammatory diseases.

Published
2021
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16. Clinical and epidemiological features of psoriasis exacerbations in children with SARS-CoV-2 infection.

Author

Skrek S, Di Lernia V, Beauchet A, Bursztejn AC, Belloni Fortina A, Lesiak A, Thomas J, Brzezinski P, Topkarci Z, Murashkin N, Torres T, Epishev R, Chiriac A, McPherson T, Akinde M, Maruani A, Luna PC, Vidaurri de la Cruz H, Mallet S, Leducq S, Sergeant M, Zitouni J, Mahil SK, Smith CH, Flohr C, Bachelez H, and Mahé E

Subjects
Child, Humans, SARS-CoV-2, Tomography, X-Ray Computed, COVID-19 complications, Psoriasis complications, Psoriasis epidemiology
Published
2023
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17. 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).

Author

Zitouni J, Bursztejn AC, Belloni Fortina A, Beauchet A, Di Lernia V, Lesiak A, Thomas J, Topkarci Z, Murashkin N, Brzezinski P, Torres T, Chiriac A, Luca C, McPherson T, Akinde M, Maruani A, Epishev R, Vidaurri de la Cruz H, Luna PC, Amy de la Bretêque M, Lasek A, Bourrat E, Bachelerie M, Mallet S, Steff M, Bellissen A, Neri I, Zafiriou E, van den Reek JMPA, Sonkoly E, Mahil SK, Smith CH, Flohr C, Bachelez H, and Mahé E

Subjects
Adolescent, Adult, Biological Factors therapeutic use, Child, Disease Progression, Humans, Methotrexate therapeutic use, Pandemics, Registries, Biological Products therapeutic use, COVID-19 complications, Psoriasis complications, Psoriasis drug therapy, Psoriasis epidemiology
Abstract

Background: The COVID-19 pandemic has raised questions regarding the management of chronic skin diseases, especially in patients on systemic treatments. Data concerning the use of biologics in adults with psoriasis are reassuring, but data specific to children are missing. Moreover, COVID-19 could impact the course of psoriasis in children., Objectives: The aim of this study was therefore to assess the impact of COVID-19 on the psoriasis of children, and the severity of the infection in relation to systemic treatments., Methods: We set up an international registry of paediatric psoriasis patients. Children were included if they were under 18 years of age, had a history of psoriasis, or developed it within 1 month of COVID-19 and had COVID-19 with or without symptoms., Results: One hundred and twenty episodes of COVID-19 in 117 children (mean age: 12.4 years) were reported. The main clinical form of psoriasis was plaque type (69.4%). Most children were without systemic treatment (54.2%); 33 (28.3%) were on biologic therapies, and 24 (20%) on non-biologic systemic drugs. COVID-19 was confirmed in 106 children (88.3%) and 3 children had two COVID-19 infections each. COVID-19 was symptomatic for 75 children (62.5%) with a mean duration of 6.5 days, significantly longer for children on non-biologic systemic treatments (P = 0.02) and without systemic treatment (P = 0.006) when compared with children on biologics. The six children who required hospitalization were more frequently under non-biologic systemic treatment when compared with the other children (P = 0.01), and particularly under methotrexate (P = 0.03). After COVID-19, the psoriasis worsened in 17 cases (15.2%). Nine children (8%) developed a psoriasis in the month following COVID-19, mainly a guttate form (P = 0.01)., Discussion: Biologics appear to be safe with no increased risk of severe form of COVID-19 in children with psoriasis. COVID-19 was responsible for the development of psoriasis or the worsening of a known psoriasis for some children., (© 2022 European Academy of Dermatology and Venereology.)

Published
2022
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18. Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study.

Author

Mahil SK, Yates M, Yiu ZZN, Langan SM, Tsakok T, Dand N, Mason KJ, McAteer H, Meynell F, Coker B, Vincent A, Urmston D, Vesty A, Kelly J, Lancelot C, Moorhead L, Bachelez H, Capon F, Contreras CR, De La Cruz C, Di Meglio P, Gisondi P, Jullien D, Lambert J, Naldi L, Norton S, Puig L, Spuls P, Torres T, Warren RB, Waweru H, Weinman J, Brown MA, Galloway JB, Griffiths CM, Barker JN, and Smith CH

Subjects
Cross-Sectional Studies, Humans, Pandemics, SARS-CoV-2, COVID-19, Psoriasis epidemiology
Published
2021
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19. Risk-mitigating behaviours in people with inflammatory skin and joint disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey.

Author

Mahil SK, Yates M, Langan SM, Yiu ZZN, Tsakok T, Dand N, Mason KJ, McAteer H, Meynell F, Coker B, Vincent A, Urmston D, Vesty A, Kelly J, Lancelot C, Moorhead L, Bachelez H, Bruce IN, Capon F, Contreras CR, Cope AP, De La Cruz C, Di Meglio P, Gisondi P, Hyrich K, Jullien D, Lambert J, Marzo-Ortega H, McInnes I, Naldi L, Norton S, Puig L, Sengupta R, Spuls P, Torres T, Warren RB, Waweru H, Weinman J, Griffiths CEM, Barker JN, Brown MA, Galloway JB, and Smith CH

Subjects
Cross-Sectional Studies, Humans, Male, Pandemics, SARS-CoV-2, COVID-19, Joint Diseases
Abstract

Background: Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse coronavirus disease 2019 (COVID-19) outcomes compared with patients receiving no systemic treatments., Objectives: We used international patient survey data to explore the hypothesis that greater risk-mitigating behaviour in those receiving targeted therapies may account, at least in part, for this observation., Methods: Online surveys were completed by individuals with psoriasis (globally) or rheumatic and musculoskeletal diseases (RMDs) (UK only) between 4 May and 7 September 2020. We used multiple logistic regression to assess the association between treatment type and risk-mitigating behaviour, adjusting for clinical and demographic characteristics. We characterized international variation in a mixed-effects model., Results: Of 3720 participants (2869 psoriasis, 851 RMDs) from 74 countries, 2262 (60·8%) reported the most stringent risk-mitigating behaviour (classified here under the umbrella term 'shielding'). A greater proportion of those receiving targeted therapies (biologics and Janus Kinase inhibitors) reported shielding compared with those receiving no systemic therapy [adjusted odds ratio (OR) 1·63, 95% confidence interval (CI) 1·35-1·97]. The association between targeted therapy and shielding was preserved when standard systemic therapy was used as the reference group (OR 1·39, 95% CI 1·23-1·56). Shielding was associated with established risk factors for severe COVID-19 [male sex (OR 1·14, 95% CI 1·05-1·24), obesity (OR 1·37, 95% CI 1·23-1·54), comorbidity burden (OR 1·43, 95% CI 1·15-1·78)], a primary indication of RMDs (OR 1·37, 95% CI 1·27-1·48) and a positive anxiety or depression screen (OR 1·57, 95% CI 1·36-1·80). Modest differences in the proportion shielding were observed across nations., Conclusions: Greater risk-mitigating behaviour among people with IMIDs receiving targeted therapies may contribute to the reported lower risk of adverse COVID-19 outcomes. The behaviour variation across treatment groups, IMIDs and nations reinforces the need for clear evidence-based patient communication on risk-mitigation strategies and may help inform updated public health guidelines as the pandemic continues., (© 2020 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Published
2021
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21. Comparing the efficacy and tolerability of biologic therapies in psoriasis: an updated network meta-analysis.

Author

Mahil SK, Ezejimofor MC, Exton LS, Manounah L, Burden AD, Coates LC, de Brito M, McGuire A, Murphy R, Owen CM, Parslew R, Woolf RT, Yiu ZZN, Uthman OA, Mohd Mustapa MF, and Smith CH

Subjects
Biological Therapy, Humans, Network Meta-Analysis, Ustekinumab, Interleukin-12, Psoriasis drug therapy
Abstract

Background: The rapid expansion of psoriasis biologics has led to an urgent need to understand their relative efficacy and tolerability to inform treatment decisions better and, specifically, to inform guideline development., Objectives: To update a 2017 meta-analysis on the comparative efficacy and tolerability of biologic treatments for psoriasis., Methods: We searched the MEDLINE, PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs), published up to 7 September 2018, of 11 licensed, NICE-approved biologics targeting tumour necrosis factor (adalimumab, etanercept, infliximab, certolizumab pegol), interleukin (IL)-12/IL-23p40 (ustekinumab), IL-17A (secukinumab, ixekizumab), IL-17RA (brodalumab) and IL-23p19 (guselkumab, tildrakizumab, risankizumab). A frequentist network meta-analysis ascertained direct or indirect evidence comparing biologics with one another, methotrexate or placebo. This was combined with hierarchical cluster analyses to consider efficacy (≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90) or Physician's Global Assessment 0 or 1; PASI 75; Dermatology Life Quality Index improvement) and tolerability (drug withdrawal due to adverse events) outcomes at 10-16 weeks, followed by assessments of study quality, heterogeneity and inconsistency., Results: We identified 62 RCTs presenting data on direct comparisons (31 899 participants). All biologics were efficacious compared with placebo or methotrexate at 10-16 weeks. Hierarchical cluster analyses revealed that adalimumab, brodalumab, certolizumab pegol, guselkumab, risankizumab, secukinumab, tildrakizumab and ustekinumab were comparable with respect to high short-term efficacy and tolerability. Infliximab and ixekizumab clustered together, with high short-term efficacy but relatively lower tolerability than the other agents, although the number of drug withdrawal events across the network was low, so these findings should be treated with caution., Conclusions: Using our methodology we found that most biologics cluster together with respect to short-term efficacy and tolerability, and we did not identify any single agent as 'best'. These data need to be interpreted in the context of longer-term efficacy, effectiveness data, safety, posology and drug acquisition costs when making treatment decisions., (© 2020 British Association of Dermatologists.)

Published
2020
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22. Global reporting of cases of COVID-19 in psoriasis and atopic dermatitis: an opportunity to inform care during a pandemic.

Author

Mahil SK, Yiu ZZN, Mason KJ, Dand N, Coker B, Wall D, Fletcher G, Bosma A, Capon F, Iversen L, Langan SM, Di Meglio P, Musters AH, Prieto-Merino D, Tsakok T, Warren RB, Flohr C, Spuls PI, Griffiths CEM, Barker J, Irvine AD, and Smith CH

Subjects
Betacoronavirus isolation & purification, COVID-19, Coronavirus Infections immunology, Coronavirus Infections therapy, Coronavirus Infections virology, Datasets as Topic, Dermatitis, Atopic drug therapy, Humans, Immunologic Factors therapeutic use, International Cooperation, Observational Studies as Topic, Pandemics, Patient Reported Outcome Measures, Pneumonia, Viral immunology, Pneumonia, Viral therapy, Pneumonia, Viral virology, Psoriasis drug therapy, Registries statistics & numerical data, SARS-CoV-2, Treatment Outcome, Betacoronavirus immunology, Coronavirus Infections epidemiology, Dermatitis, Atopic immunology, Global Burden of Disease statistics & numerical data, Pneumonia, Viral epidemiology, Psoriasis immunology
Published
2020
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23. Psoriasis treat to target: defining outcomes in psoriasis using data from a real-world, population-based cohort study (the British Association of Dermatologists Biologics and Immunomodulators Register, BADBIR).

Author

Mahil SK, Wilson N, Dand N, Reynolds NJ, Griffiths CEM, Emsley R, Marsden A, Evans I, Warren RB, Stocken D, Barker JN, Burden AD, and Smith CH

Subjects
Adult, Cohort Studies, Dermatologists, Ethnicity, Female, Humans, Immunologic Factors, Male, Middle Aged, Severity of Illness Index, Treatment Outcome, Biological Products therapeutic use, Psoriasis drug therapy
Abstract

Background: The 'treat to target' paradigm improves outcomes and reduces costs in chronic disease management but is not yet established in psoriasis., Objectives: To identify treatment targets in psoriasis using two common measures of disease activity: Psoriasis Area and Severity Index (PASI) and Physician's Global Assessment (PGA)., Methods: Data from a multicentre longitudinal U.K. cohort of patients with psoriasis receiving systemic or biologic therapies (British Association of Dermatologists Biologics and Immunomodulators Register, BADBIR) were used to identify absolute PASI thresholds for 90% (PASI 90) and 75% (PASI 75) improvements in baseline disease activity, using receiver operating characteristic curves. The relationship between PGA (clear, almost clear, mild, moderate, moderate-severe, severe) and PASI (range 0-72) was described, and the concordance between absolute and relative definitions of response was determined. The same approach was used to establish treatment response and eligibility definitions based on PGA., Results: Data from 13 422 patients were available (58% male, 91% white ethnicity, mean age 44·9 years), including over 23 000 longitudinal PASI and PGA scores. An absolute PASI ≤ 2 was concordant with PASI 90 and an absolute PASI ≤ 4 was concordant with PASI 75 in 90% and 88% of cases, respectively. These findings were robust to subgroups of timing of assessment, baseline disease severity and treatment modality. PASI and PGA were strongly correlated (Spearman's rank correlation coefficient 0·92). The median PASI increased from 0 (interquartile range 0-0, range 0-23) to 19 (interquartile range 15-25, range 0-64) for PGA clear to severe, respectively. PGA clear/almost clear was concordant with PASI ≤ 2 in 90% of cases, and PGA moderate-severe severe was concordant with the National Institute for Health and Care Excellence PASI eligibility criteria for biologics in 81% of cases., Conclusions: An absolute PASI ≤ 2 and PGA clear/almost clear represent relevant disease end points to inform treat-to-target management strategies in psoriasis. What's already known about this topic? The most commonly used relative disease activity measure in psoriasis is ≥ 90% improvement in Psoriasis Area and Severity Index (PASI 90); however, it has several limitations including dependency on a baseline severity assessment. Defining an absolute target disease activity end point in psoriasis has the potential to improve patient outcomes and reduce costs, as demonstrated by treat-to-target approaches in other chronic diseases such as hypertension and diabetes. The Physician's Global Assessment (PGA) is a popular alternative measure of psoriasis severity in daily practice; however, its utility has not been formally assessed with respect to PASI. What does this study add? An absolute PASI ≤ 2 corresponds with PASI 90 response and is a relevant disease end point for treat-to-target approaches in psoriasis. There is a strong correlation between PASI and PGA. PGA moderate-severe/severe may serve as an alternative eligibility criterion for biologics to PASI-based definitions, and PGA clear/almost clear is an appropriate alternative absolute treatment end point. What are the clinical implications of this work? Absolute PASI ≤ 2 and PGA clear/almost clear represent relevant disease end points to inform treat-to-target management strategies in psoriasis., (© 2019 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)

Published
2020
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24. Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis? A Critically Appraised Topic.

Author

Mahil SK, McSweeney SM, Kloczko E, McGowan B, Barker JN, and Smith CH

Subjects
Arthritis, Psoriatic epidemiology, Arthritis, Psoriatic etiology, Arthritis, Psoriatic therapy, Humans, Incidence, Life Style, Obesity complications, Psoriasis epidemiology, Psoriasis etiology, Psoriasis therapy, Randomized Controlled Trials as Topic, Severity of Illness Index, Treatment Outcome, Weight Loss, Arthritis, Psoriatic diagnosis, Bariatric Surgery, Diet, Reducing, Obesity therapy, Psoriasis diagnosis
Abstract

Clinical Question: Does weight loss reduce the severity and incidence of psoriasis or psoriatic arthritis (PsA) in obese individuals?, Background: Obesity presents a rising public health challenge and is more prevalent among individuals with psoriasis or PsA than in the general population. Longitudinal population-based studies suggest a causal role for obesity in psoriasis and PsA onset and that obesity drives greater disease severity., Methods: We systematically reviewed evidence within the MEDLINE, Embase and CENTRAL databases and clinical trials registries examining lifestyle, pharmacological and surgical weight loss interventions in the treatment and prevention of psoriasis and PsA in obese individuals. Meta-analysis was conducted using random-effects models, followed by sensitivity analyses., Results: Of 176 full-text articles reviewed, 14 met the inclusion criteria. Meta-analysis of six randomized control trials (RCTs) confirmed that weight loss following lifestyle interventions (diet or physical activity) improves psoriasis compared with control [mean change in Psoriasis Area and Severity Index -2·59, 95% confidence interval (CI) -4·09 to -1·09; P < 0·001]. One RCT demonstrated a greater likelihood of achieving minimal PsA activity following diet-induced weight loss (odds ratio 4·20, 95% CI 1·82-9·66; P < 0·001). Three studies of pharmacological treatments reported conflicting results, and no RCTs of bariatric surgery were identified. Two cohort studies suggested that bariatric surgery, particularly gastric bypass, reduces the risk of developing psoriasis (hazard ratio 0·52, 95% CI 0·33-0·81; P < 0·01)., Conclusions: These limited data indicate that weight loss can improve pre-existing psoriasis and PsA, and prevent the onset of psoriasis in obese individuals. Together with the National Institute for Health and Care Excellence obesity guidance, this informed a local obesity screening and management pathway, providing multidisciplinary weight loss interventions alongside conventional skin-focused care for patients with psoriasis., (© 2019 British Association of Dermatologists.)

Published
2019
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