High Risk of Bias Associated With Studies of COVID-19 Risk in Patients with Psoriasis, Psoriatic Arthritis


Research into the risk and outcomes of COVID-19 in patients with psoriasis and psoriatic arthritis treated with biological therapies has a high risk of bias and quality issues, according to a systematic evaluation published in the Journal of Investigative Dermatology. The investigators concluded that a definite statement on risk or management recommendations cannot be made based on currently published data.

“Our study is not intended as a criticism to the authors or the journals that published their research,” said Stefano Piaserico, MD, PhD, in a press release. “Rather, it is a reminder to be careful when reading new COVID-19 papers. During a pandemic, health care providers should be more cautious when incorporating evidence from new studies into personal decision making.”

According to the investigators, dermatologists have been concerned since the beginning of the pandemic about an increased risk of infection or worse outcomes in patients treated with biological therapies for psoriasis or psoriatic arthritis. Certain studies have reported an increased risk of respiratory infection in patients treated with biologics, whereas other studies have suggested these same biologics are potential treatments for COVID-19.

The investigators analyzed 25 papers centered on the risk and outcomes of COVID-19 in patients receiving biologic treatment for psoriasis or psoriatic arthritis using the Newcastle-Ottowa Scale (NOS). This scale is a point-based system intended to evaluate studies using 8 different criteria, including selection of study groups, comparability of the groups, exposure, and outcome. The highest score possible is 9 stars, with a score of 6 or greater (75% or greater) considered a low risk of bias.

The study found that the median score for all studies reviewed was 47.2% for psoriasis studies and 44.4% for psoriatic arthritis studies. According to the investigators, the majority of studies were performed in referral hospital centers and no population-based studies were published, leading to selection bias.

“COVID-19 was, and still is, an unknown disease and there was an urgent need to collect and publish data,” Piaserico said. “Against this backdrop, traditional peer-review systems have been stressed by the enormous number of COVID-19–related manuscripts. Everyone agreed on the fact that little, even flawed, data were better than no data.”

The investigators provided numerous, specific recommendations for future studies. These include multicenter collaboration that prioritizes data collection and a system to rapidly activate formal epidemiological studies and registries in the event of a global health crisis, as well as international study coordination and data sharing.


Studies of COVID-19 risk in patients with psoriasis and psoriatic arthritis appear biased [news release]. EurekAlert; August 4, 2021. Accessed August 5, 2021. https://www.eurekalert.org/news-releases/924188

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