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Article ; Online: A UK online survey exploring patient perspectives of remote consultations for managing psoriasis and psoriatic arthritis during the SARS-CoV-2 pandemic.

Hewitt, Rachael M / Urmston, Dominic / Mcateer, Helen / Schofield, Julia / Bundy, Chris

2022 Volume 28, Issue 10, Page(s) 3163–3176

Abstract: The use of remote consultations via telephone or video can contribute to the management of people with psoriasis and has allowed continuity of patient care throughout the SARS-CoV-2 pandemic, though little is known about the patient experience. The ... ...

Abstract	The use of remote consultations via telephone or video can contribute to the management of people with psoriasis and has allowed continuity of patient care throughout the SARS-CoV-2 pandemic, though little is known about the patient experience. The present study aimed to provide insights into the views and experiences of people with psoriasis and psoriatic arthritis on their remote consultations during the SARS-CoV-2 pandemic and develop guidance for patients and healthcare professionals on how to optimise future remote consultations. We conducted a cross-sectional, on-line survey of people with psoriasis and psoriatic arthritis. Data were analysed using descriptive statistics and Thematic Analysis. Overall, 126 people reported experiences of telephone (92%) or video (8%) consultations. Most participants were satisfied with (78%), and were happy for, remote consultations to continue (21%); few were not (5%). Others did not always want remote consultations (39%) and preferred alternating with face-to-face consultations (18%). Some wanted remote care during the pandemic only (17%). Five themes were identified: (1)
MeSH term(s)	Humans ; Arthritis, Psoriatic/therapy ; SARS-CoV-2 ; Remote Consultation ; Cross-Sectional Studies ; Pandemics ; COVID-19 ; Psoriasis/therapy ; United Kingdom
Language	English
Publishing date	2022-08-08
Publishing country	England
Document type	Journal Article
ZDB-ID	1477841-5
ISSN	1465-3966 ; 1354-8506
ISSN (online)	1465-3966
ISSN	1354-8506
DOI	10.1080/13548506.2022.2104883
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Article ; Online: 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.

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

The British journal of dermatology

2021 Volume 185, Issue 1, Page(s) 80–90

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 ... ...

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.
MeSH term(s)	COVID-19 ; Cross-Sectional Studies ; Humans ; Joint Diseases ; Male ; Pandemics ; SARS-CoV-2
Language	English
Publishing date	2021-03-09
Publishing country	England
Document type	Journal Article
ZDB-ID	80076-4
ISSN	1365-2133 ; 0007-0963
ISSN (online)	1365-2133
ISSN	0007-0963
DOI	10.1111/bjd.19755
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Article ; Online: Describing the burden of the COVID-19 pandemic in people with psoriasis: findings from a global cross-sectional study.

Mahil, S K / Yates, M / Yiu, Z Z N / Langan, S M / 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 / 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

Journal of the European Academy of Dermatology and Venereology : JEADV

2021 Volume 35, Issue 10, Page(s) e636–e640

MeSH term(s)	COVID-19 ; Cross-Sectional Studies ; Humans ; Pandemics ; Psoriasis/epidemiology ; SARS-CoV-2
Language	English
Publishing date	2021-08-19
Publishing country	England
Document type	Letter
ZDB-ID	1128828-0
ISSN	1468-3083 ; 0926-9959
ISSN (online)	1468-3083
ISSN	0926-9959
DOI	10.1111/jdv.17450
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Article ; Online: Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey.

Quirke-McFarlane, Sophia / Weinman, John / Cook, Emma S / Yiu, Zenas Z N / Dand, Nick / Langan, Sinead M / Bechman, Katie / Tsakok, Teresa / Mason, Kayleigh J / McAteer, Helen / Meynell, Freya / Coker, Bolaji / Vincent, Alexandra / Urmston, Dominic / Vesty, Amber / Kelly, Jade / Lancelot, Camille / Moorhead, Lucy / Barbosa, Ines A /

The British journal of dermatology

2023 Volume 188, Issue 5, Page(s) 610–617

Abstract: Background: Nonadherence to immune-modifying therapy is a complex behaviour which, before the COVID-19 pandemic, was shown to be associated with mental health disorders in people with immune-mediated diseases. The COVID-19 pandemic has led to a rise in ... ...

Abstract	Background: Nonadherence to immune-modifying therapy is a complex behaviour which, before the COVID-19 pandemic, was shown to be associated with mental health disorders in people with immune-mediated diseases. The COVID-19 pandemic has led to a rise in the global prevalence of anxiety and depression, and limited data exist on the association between mental health and nonadherence to immune-modifying therapy during the pandemic. Objectives: To assess the extent of and reasons underlying nonadherence to systemic immune-modifying therapy during the COVID-19 pandemic in individuals with psoriasis, and the association between mental health and nonadherence. Methods: Online self-report surveys (PsoProtectMe), including validated screens for anxiety and depression, were completed globally during the first year of the pandemic. We assessed the association between anxiety or depression and nonadherence to systemic immune-modifying therapy using binomial logistic regression, adjusting for potential cofounders (age, sex, ethnicity, comorbidity) and country of residence. Results: Of 3980 participants from 77 countries, 1611 (40.5%) were prescribed a systemic immune-modifying therapy. Of these, 408 (25.3%) reported nonadherence during the pandemic, most commonly due to concerns about their immunity. In the unadjusted model, a positive anxiety screen was associated with nonadherence to systemic immune-modifying therapy [odds ratio (OR) 1.37, 95% confidence interval (CI) 1.07-1.76]. Specifically, anxiety was associated with nonadherence to targeted therapy (OR 1.41, 95% CI 1.01-1.96) but not standard systemic therapy (OR 1.16, 95% CI 0.81-1.67). In the adjusted model, although the directions of the effects remained, anxiety was not significantly associated with nonadherence to overall systemic (OR 1.20, 95% CI 0.92-1.56) or targeted (OR 1.33, 95% CI 0.94-1.89) immune-modifying therapy. A positive depression screen was not strongly associated with nonadherence to systemic immune-modifying therapy in the unadjusted (OR 1.22, 95% CI 0.94-1.57) or adjusted models (OR 1.14, 95% CI 0.87-1.49). Conclusions: These data indicate substantial nonadherence to immune-modifying therapy in people with psoriasis during the pandemic, with attenuation of the association with mental health after adjusting for confounders. Future research in larger populations should further explore pandemic-specific drivers of treatment nonadherence. Clear communication of the reassuring findings from population-based research regarding immune-modifying therapy-associated adverse COVID-19 risks to people with psoriasis is essential, to optimize adherence and disease outcomes.
MeSH term(s)	Humans ; COVID-19/epidemiology ; Cross-Sectional Studies ; Pandemics ; Anxiety/epidemiology ; Anxiety/psychology ; Psoriasis/drug therapy ; Psoriasis/epidemiology ; Depression/epidemiology
Language	English
Publishing date	2023-02-10
Publishing country	England
Document type	Journal Article
ZDB-ID	80076-4
ISSN	1365-2133 ; 0007-0963
ISSN (online)	1365-2133
ISSN	0007-0963
DOI	10.1093/bjd/ljac144
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Article ; Online: Vaccine hesitancy and access to psoriasis care in the COVID-19 pandemic: findings from a global patient-reported cross-sectional survey.

Bechman, K / Cook, ES / Dand, N / Yiu, ZZN / Tsakok, T / Meynell, F / Coker, B / Vincent, A / Bachelez, H / Barbosa, I / Brown, MA / Capon, F / Contreras, CR / De La Cruz, C / Di Meglio, P / Gisondi, P / Jullien, D / Kelly, J / Lambert, J /

Lancelot, C / Langan, SM / Mason, KJ / McAteer, H / Moorhead, L / Naldi, L / Norton, S / Puig, L / Spuls, P / Torres, T / Urmston, D / Vesty, A / Warren, RB / Waweru, H / Weinman, J / Griffiths, CEM / Barker, JN / Smith, CH / Galloway, JB / Mahil, SK

medRxiv

Abstract: Background: COVID-19 vaccination is efficacious at protecting against severe COVID-19 outcomes in the general population. However, vaccine hesitancy (unwillingness for vaccination despite available vaccination services) threatens public health. ... ...

Abstract	Background: COVID-19 vaccination is efficacious at protecting against severe COVID-19 outcomes in the general population. However, vaccine hesitancy (unwillingness for vaccination despite available vaccination services) threatens public health. Individuals taking immunosuppression for psoriasis have been prioritised for COVID-19 vaccination, however there is a paucity of information on vaccine hesitancy in this population, including contributing factors. While global healthcare has been severely disrupted in the pandemic, the impact on access to psoriasis care and whether this may negatively influence vaccine uptake, is underexplored. Objectives: To explore organisational and individual factors associated with COVID-19 vaccine hesitancy in individuals with psoriasis. Methods: Individuals with psoriasis, identified through global patient organisations and social media, completed a cross-sectional self-reported online survey. The primary outcome was COVID-19 vaccine hesitancy. Logistic regression was used to examine the association between predictor variables (organisational and individual factors) and outcome. Results: Self-reported data from 802 individuals with psoriasis across 89 countries were available (65.6% female, median age 51 years [IQR 37-61], 43.7% taking systemic immunosuppression). Eight percent (n=63) reported vaccine hesitancy. Those reporting vaccine hesitancy were younger, more likely to be of non-white ethnicity, non-UK resident, have a lower BMI, not taking systemic immunosuppression and with shorter disease duration compared to those not reporting vaccine hesitancy. The commonest reasons for vaccine hesitancy were concerns regarding vaccine side-effects, that the vaccine is too new or that psoriasis may worsen post-vaccination. Forty percent (n=322) reported that their psoriasis care had been disrupted by the pandemic. These individuals were younger, of non-white ethnicity, with shorter duration and more severe psoriasis. Disruption to psoriasis care was associated with vaccine hesitancy (unadjusted OR 2.97 (95%CI 1.23-7.13), p=0.015), although not statistically significant in the adjusted model. Conclusion: A minority of individuals with psoriasis from our study reported COVID-19 vaccine hesitancy. Similar to general population trends, vaccine hesitancy in our psoriasis sample is most common in younger age and ethnic minority groups. Our data highlight patient concerns regarding COVID-19 vaccination, which are important to address during patient-clinician interactions to help optimise vaccine uptake and mitigate risks from the ongoing pandemic in individuals with psoriasis.
Keywords	covid19
Language	English
Publishing date	2022-01-23
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2022.01.20.22269546
Database	COVID19

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Article ; Online: Vaccine hesitancy and access to psoriasis care during the COVID-19 pandemic: findings from a global patient-reported cross-sectional survey.

Bechman, Katie / Cook, Emma S / Dand, Nick / Yiu, Zenas Z N / Tsakok, Teresa / Meynell, Freya / Coker, Bolaji / Vincent, Alexandra / Bachelez, Herve / Barbosa, Ines / Brown, Matthew A / Capon, Francesca / Contreras, Claudia R / De La Cruz, Claudia / Meglio, Paola Di / Gisondi, Paolo / Jullien, Denis / Kelly, Jade / Lambert, Jo /

The British journal of dermatology

2022 Volume 187, Issue 2, Page(s) 254–256

MeSH term(s)	COVID-19/prevention & control ; Cross-Sectional Studies ; Humans ; Pandemics ; Patient Reported Outcome Measures ; Psoriasis/drug therapy ; Vaccination ; Vaccination Hesitancy
Language	English
Publishing date	2022-05-03
Publishing country	England
Document type	Letter
ZDB-ID	80076-4
ISSN	1365-2133 ; 0007-0963
ISSN (online)	1365-2133
ISSN	0007-0963
DOI	10.1111/bjd.21042
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Article ; Online: Risk mitigating behaviours in people with inflammatory joint and skin disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey

Mahil, S. K. / Yates, M. / Langan, S. M. / Yiu, Z. Z. / Tsakok, T. / Dand, N. / Mason, K. J. / McAteer, H. / Meynall, F. / Coker, B. / Vincent, A. / Urmston, D. / Vesty, A. / Kelly, J. / Lancelot, C. / Moorhead, L. / Bachelez, H. / Bruce, I. N. / Capon, F. /

Abstract: Objectives Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. We used international ... ...

Abstract	Objectives Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. 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 Rheumatic and Musculoskeletal Diseases (RMD) (UK only) or psoriasis (globally) between 4th May and 7th 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 characterised international variation in a mixed effects model. Results Of 3,720 participants (2,869 psoriasis, 851 RMD) from 74 countries, 2,262 (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 JAK inhibitors) reported shielding compared to those receiving no systemic therapy (adjusted odds ratio [OR] 1.63, 95% CI 1.35-1.97) and standard systemic agents (OR 1.39, 95% CI 1.22-1.56). Shielding was associated with established risk factors for severe COVID-19 (male sex [OR 1.14, 95% CI 1.05-1.24], obesity [OR 1.38, 95% CI 1.23-1.54], comorbidity burden [OR 1.43, 95% CI 1.15-1.78]), a primary indication of RMD (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.
Keywords	covid19
Publisher	MedRxiv; WHO
Document type	Article ; Online
DOI	10.1101/2020.11.05.20226662
Database	COVID19

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

Mahil, Satveer K / Yates, Mark / Yiu, Zenas Z / Langan, Sinead M / Tsakok, Teresa / Dand, Nick / Mason, Kayleigh J / McAteer, Helen / Meynall, Freya / Coker, Bolaji / Vincent, Alexandra / Urmston, Dominic / Vesty, Amber / Kelly, Jade / Lancelot, Camille / Moorhead, Lucy / Bachelez, Herve / Capon, Francesca / Contreras, Claudia R /

De La Cruz, Claudia / Di Meglio, Paola / Gisondi, Paolo / Jullien, Denis / Lambert, Jo / Naldi, Luigi / Norton, Sam / Puig, Luis / Spuls, Phyllis / Torres, Tiago / Warren, Richard B / Waweru, Hoseah / Weinman, John / Brown, Matt A / Galloway, James B / Griffiths, Christopher M / Barker, Jonathan N / Smith, Catherine H

medRxiv

Abstract: Background Indirect excess morbidity has emerged as a major concern in the COVID-19 pandemic. People with psoriasis may be particularly vulnerable to this because of prevalent anxiety and depression, multimorbidity and therapeutic use of ... ...

Abstract	Background Indirect excess morbidity has emerged as a major concern in the COVID-19 pandemic. People with psoriasis may be particularly vulnerable to this because of prevalent anxiety and depression, multimorbidity and therapeutic use of immunosuppression. Objective Characterise the factors associated with worsening psoriasis in the COVID-19 pandemic, using mental health status (anxiety and depression) as the main exposure of interest. Methods Global cross-sectional study using a primary outcome of self-reported worsening of psoriasis. Individuals with psoriasis completed an online self-report questionnaire (PsoProtectMe; Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection Me) between May 2020 and January 2021. Each individual completed a validated screen for anxiety (Generalized Anxiety Disorder-2) and depression (Patient Health Questionnaire-2). Odds ratios (OR) and 95% confidence intervals (CI) were estimated using multivariable logistic regression. Results 4,043 people with psoriasis (without COVID-19) from 86 countries self-reported to PsoProtectMe (mean age 47.2 years [SD 15.1]; mean BMI 27.6kg/m2 [SD 6.0], 2,684 [66.4%] female and 3,016 [74.6%] of white European ethnicity). 1,728 (42.7%) participants (1322 [77%] female) reported worsening of their psoriasis in the pandemic. A positive screen for anxiety or depression associated with worsening psoriasis in age and gender adjusted (OR 2.04, 95% CI 1.77-2.36), and fully adjusted (OR 2.01, 95% CI 1.72-2.34) logistic regression models. Female sex, obesity, shielding behaviour and systemic immunosuppressant non-adherence also associated with worsening psoriasis. The commonest reason for non-adherence was concern regarding complications related to COVID-19. Conclusions These data indicate an association between poor mental health and worsening psoriasis in the pandemic. Access to holistic care including psychological support may mitigate potentially long-lasting effects of the pandemic on health outcomes in psoriasis. The study also highlights an urgent need to address patient concerns about immunosuppressant-related risks, which may be contributing to non-adherence.
Keywords	covid19
Language	English
Publishing date	2021-05-06
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2021.05.04.21256507
Database	COVID19

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Article ; Online: Risk mitigating behaviours in people with inflammatory joint and skin disease during the COVID-19 pandemic differ by treatment type: a cross-sectional patient survey

Mahil, Satveer K / Yates, Mark / Langan, Sinead M / Yiu, Zenas ZN / Tsakok, Teresa / Dand, Nick / Mason, Kayleigh J / McAteer, Helen / Meynall, Freya / Coker, Bolaji / Vincent, Alexandra / Urmston, Dominic / Vesty, Amber / Kelly, Jade / Lancelot, Camille / Moorhead, Lucy / Bachelez, Herve / Bruce, Ian N / Capon, Francesca /

medRxiv

Abstract	Objectives Registry data suggest that people with immune-mediated inflammatory diseases (IMIDs) receiving targeted systemic therapies have fewer adverse COVID-19 outcomes compared to patients receiving no systemic treatments. 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 Rheumatic and Musculoskeletal Diseases (RMD) (UK only) or psoriasis (globally) between 4th May and 7th 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 characterised international variation in a mixed effects model. Results Of 3,720 participants (2,869 psoriasis, 851 RMD) from 74 countries, 2,262 (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 JAK inhibitors) reported shielding compared to those receiving no systemic therapy (adjusted odds ratio [OR] 1.63, 95% CI 1.35-1.97) and standard systemic agents (OR 1.39, 95% CI 1.22-1.56). Shielding was associated with established risk factors for severe COVID-19 (male sex [OR 1.14, 95% CI 1.05-1.24], obesity [OR 1.38, 95% CI 1.23-1.54], comorbidity burden [OR 1.43, 95% CI 1.15-1.78]), a primary indication of RMD (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.
Keywords	covid19
Language	English
Publishing date	2020-11-07
Publisher	Cold Spring Harbor Laboratory Press
Document type	Article ; Online
DOI	10.1101/2020.11.05.20226662
Database	COVID19

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