Non-adherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey

BACKGROUND

Non-adherence 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 non-adherence to immune modifying therapy during the pandemic.

OBJECTIVES

To assess the extent of and reasons underlying non-adherence to systemic immune-modifying therapy during the COVID-19 pandemic in individuals with psoriasis, and the association between mental health and non-adherence.

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 non-adherence 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 non-adherence during the pandemic, most commonly due to concerns about their immunity. In the unadjusted model, a positive anxiety screen was associated with non-adherence to systemic immune-modifying therapy (OR 1.36, 95%CI 1.07-1.76). Specifically, anxiety was associated with non-adherence 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 non-adherence 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 non-adherence 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).

CONCLUSION

These data indicate substantial non-adherence 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 non-adherence. 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 optimise adherence and disease outcomes.

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

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.

Sulfur compounds reactivity in the ODS of model and real feeds on W–SBA based catalysts

W based catalysts were synthesized by dry impregnation of SBA-15 mesoporous silica with phosphotungstic acid (HPW) solution with W contents between 5 and 20%, the HPW compound being preserved after calcination. The catalysts performance and the reactivity of various sulfide compounds were evaluated in the oxidative desulfurization (ODS) of model solutions and of real diesels, with sulfur contents ranging from 50 to 2000 ppm. The reactivity of benzothiophene and dibenzothiophene compounds was different in the ODS of model solutions but globally identical in the ODS of SRGO. The monitoring of the concentration of a range of alkyl DBT compounds (with alkyl groups from C2 to C5) in LGO confirmed the importance of the steric hindrance of alkyl substituents in the 4,6 position near the S atom, as well as of the size of the alkyl groups. Among the xW/SBA series, the catalyst with the highest loading showed the best performance in the ODS of LGO and SRGO while the catalysts efficiency could not be discriminated in the ODS of model solutions. In the ODS of both model solutions and real feeds, the W/SBA catalyst was found to be much more efficient than a catalyst obtained by impregnation of a commercial silica with similar loading, highlighting the beneficial use of a mesoporous support with high surface area and pore volume that allowed well-dispersed tungsten species to be obtained. The quantity of sulfones precipitated and/or retained on the catalyst depended on the feed and was found to be higher in the ODS of model solution than in the ODS of real feeds. The precipitated/retained sulfones on the support may induce catalyst deactivation, which highlights the importance of the textural properties of the support. This detailed study points out the difficulty of extrapolating results obtained in the ODS of model solution to the ODS of real feeds.

Comparison of model and real feedstocks oxidative desulfurization on tungsten based catalysts supported on SBA.

Molecular approach to prepare mixed MoW alumina supported hydrotreatment catalysts using H4SiMonW12−nO40 heteropolyacids

Higher catalytic conversions and different selectivity ratios are explained by the formation of the mixed (MoW)S₂ active phase when using mixed MoW heteropolyacid as starting material.

Nano-engineered hierarchical porous silicas for enhanced catalytic efficiency in the liquid phase

By tailoring the pore properties (size, morphology and orientation) of hierarchical catalysts, we show experimentally the importance of active phase accessibility on catalytic efficiency.

[Eating behavior in pediatric obesity: Of the advantages of combining the neurobiological and neuropsychological approaches]

Obesity is currently considered a major public health concern, as shown by the growing number of people with excess weight, alarmingly in infants, and despite medical care. Many studies have underlined the reasons for medical care failure caused by an inability to sustain a resistant behavior towards palatable food (high sugar and fat content). Hence, previous research has highlighted connections between excessive eating behavior and the activity of neurotransmitters in brain areas involved in affective behavior and the reward circuit. Reduction of the dopaminergic activity in the prefrontal orbital and limbic cortex may raise the question of executive skills, which play a major role in social adaptation and behavior control. These findings remind us of the need to grasp environmental and behavioral factors to better identify cognitive and affective profiles and improve childhood obesity treatment.

Restraining deactivation of hierarchical zeolite supported NiW catalysts in the HDS of thiophene

Improvement of the catalytic performances in thiophene HDS on NiW sulfides catalysts supported on commercial Beta (NiW/HB) and hierarchical Beta (NiW/HB-M) were studied by mechanical mixture with γ-Al₂O₃ (NiW/Al₂O₃) or Na⁺-exchange of the zeolites.

Mesoscale Iron Enrichment Experiments 1993-2005: Synthesis and Future Directions

Since the mid-1980s, our understanding of nutrient limitation of oceanic primary production has radically changed. Mesoscale iron addition experiments (FeAXs) have unequivocally shown that iron supply limits production in one-third of the world ocean, where surface macronutrient concentrations are perennially high. The findings of these 12 FeAXs also reveal that iron supply exerts controls on the dynamics of plankton blooms, which in turn affect the biogeochemical cycles of carbon, nitrogen, silicon, and sulfur and ultimately influence the Earth climate system. However, extrapolation of the key results of FeAXs to regional and seasonal scales in some cases is limited because of differing modes of iron supply in FeAXs and in the modern and paleo-oceans. New research directions include quantification of the coupling of oceanic iron and carbon biogeochemistry.

The association between receptive nonverbal processing abilities and internalizing/externalizing problems in girls and boys

Social adjustment correlates of individual differences in receptive nonverbal processing abilities in boys and girls were investigated. Participants were 26 boys and 13 girls, mean age 12.04 years, who were in a custodial care institution for the treatment of a wide range of psychological difficulties. They completed the Diagnostic Analysis of Nonverbal Accuracy (DANVA; Nowicki & Duke, 1994), a standardized test of receptive nonverbal processing abilities. Trained raters used institutional records to assess the number and type of problems (internalizing or externalizing) experienced by each child. Teachers completed a social adjustment scale for each child. Girls' scores on the DANVA tests of child facial expression, child and adult facial expression combined, posture, and total DANVA accuracy as well as teacher ratings of social adjustment were significantly related to the number of externalizing problems they had. No other relations were significant. The findings suggest that receptive nonverbal processing skills may be more important for social adjustment for girls than for boys.

Lack of bone accretion and amenorrhea: evidence for a relative osteopenia in weight-bearing bones

Bone mineral density (BMD) was studied in young exercising amenorrheic girls to determine if density was compromised and the change related to injury. Ninety-eight volunteers (professional ballet dancers and controls) were studied in a cross-sectional study. Dancers and controls were further subdivided into normally cycling and amenorrheic subjects. Amenorrhea significantly lowered bone density of the spine (P less than 0.0001), wrist (P less than 0.03), and metatarsal (P less than 0.01); effects on the wrist were eliminated by controlling for age while controlling for weight eliminated all effects of amenorrhea at three sites. BMD of the metatarsal, a weight-bearing bone, showed an interaction between amenorrhea and dancing (exercising) P less than 0.035); surprisingly, dancing was associated with a further lowering of bone density. This interaction was eliminated when controlling for age, but not when controlling for weight. With multiple comparisons of the groups, spine, wrist, and metatarsal bone density was significantly lower in amenorrheic dancers when compared to normal dancers (P less than 0.05), even when controlling for age and weight in the metatarsal (P less than 0.05), and age in the spine (P less than 0.05). Estradiol levels correlated with bone density of both the wrist and the spine (r = 0.25, r = 0.23, P less than 0.02). Metatarsal density correlated with estradiol levels only in the dancers (r = 0.34, P less than 0.02). The only variable found to correlate with the occurrence of stress fractures was age of menarche. This was also the only variable of 9 (BMD of the wrist, spine or foot, calories ingested and expended, amount of calcium ingested, involvement in high energy activity, age of menarche or presence of amenorrhea) to predict stress fractures. Thus, BMD is significantly affected by the presence of amenorrhea but the effects are generally weight dependent. The compensatory increase in bone density generally seen in stressed bones, such as the metatarsal in ballet dancers, is deficient in amenorrheic premenopausal women even when controlling for weight but this effect may be age and estrogen dependent. Bone mass may not accumulate in the same manner in adolescents as in the mature women, thus putting them at risk for injury.