Study finds previous research on COVID-19 risk and skin conditions appear biased

A systematic evaluation of research on the risk and outcomes of the novel coronavirus (COVID-19) in patients with psoriasis and psoriatic arthritis treated with biological therapies has found high risk of bias in all the studies, among other quality issues, according to a new study published in the Journal of Investigative Dermatology.

Since the beginning of the COVID-19 pandemic, there has been concern among dermatologists about increased risk of infection or worse outcomes in patients treated with biological therapies or psoriasis or psoriatic arthritis. Some studies have reported an increased risk of respiratory infection in patients treated with biologics, while these same drugs have been proposed as possible treatments for COVID-19.

For the study, researchers analyzed the quality of 25 papers dealing with the risk and outcomes of COVID-19 in patients receiving biologic treatment for psoriasis or psoriatic arthritis using the Newcastle-Ottowa Scale (NOS). This tool is a point-based system that evaluates studies based on eight different criteria including selection of study groups, comparability of the groups, exposure, and outcome. The highest possible score is nine stars, with six or higher or greater than 75 percent considered to have a low risk of bias. The investigators also considered other factors for validation including case definition, modality of COVID-19 assessment, and evidence for participant self-selection.

The median score for all studies reviewed was 47.2 percent for psoriasis studies and 44.4 percent for psoriatic arthritis studies, indicating a high risk of bias. Most studies were performed in referral hospital centers and no population-based studies were published, leading to selection bias.

The authors conclude that neither a definite statement on risk nor management recommendations can be made based on currently published data. They provided specific recommendations for future studies. Multicenter collaboration prioritizing data collection and a system to rapidly activate formal epidemiological studies and registries when global health crises strike should be considered, with international study coordination and data sharing.

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