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.

Sigmoid volvulus in a young patient

The case of an 18-year-old man with sigmoid volvulus and recurrent abdominal pain is presented. He was seen in the emergency department three times in a 4-month period, each time complaining of cramping left lower quadrant pain of one to two hours duration without vomiting or diarrhea. Physical examination on each occasion revealed left lower quadrant tenderness without mass, guarding, or rebound. Radiologic evaluation on the first visit revealed sigmoid volvulus, which was reduced by barium enema. Despite identical clinical presentation on two subsequent occasions, radiologic studies showed no evidence of recurrent volvulus. During the ensuing two years, the patient has had no further symptoms.

Screening of certain anaesthetic agents for their ability to elicit acute porphyric phases in susceptible patients

The activity of delta-aminolaevulinic acid synthetase (E.C. 2.3.1.37) (ALA-S) was measured in rat liver after the simultaneous administration of various anesthetic agents and 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) in vivo. Flunitrazepam, Althesin and phenobarbitone caused a significant increase in the activity of the enzyme which was not observed with propanidid, etomidate and minaxolone. It is suggested that DDC-treated rat, which resembles latent human variegate porphyria, may be a more valid method of testing drugs for their ability to elicit acute porphyric phases in susceptible individuals. The anaesthetic agents which induced the activity of hepatic ALA-S in this model are not recommended in patients with genetic hepatic porphyria.

Comparison of stationary phases in reversed-phase TLC for correlation between structure and biological response of probiotics

A series of C16,C18 and C20 fatty acids and their ethyl esters and alcohols were investigated as possible stationary phases in reversed-phase TLC for the correlation between structure and biological response (antistaphylococcal activity). Ten probiotics (omego-amino acids and their L-histidine dipeptides) were used as the biologically active compounds. The mobile phase was 70% acetone in water. The best correlations were obtained with hexadecanoic acid (palmitic acid) or cis9,cis-12,cis-15-octadecatrienoic acid, 1-hexadecanol or cis-9-octadeconol, and ethyl hexadecanoate for the fatty acids, their alcohols, and their ethyl esters, respectively. Among all compounds, the following relation was obtained: fatty acids = alcohols greater than ethyl esters greater than white paraffin oil.

Selective effect of fractions of a yeast extract (PCO) on normal and malignant cells

The selective action of two fractions of PCO (a yeast extract) on normal and malignant cells was demonstrated. In vivo, the mitotic activity of malignant cells was inhibited by the methanol-insoluble fraction of PCO, whereas the methanol-soluble fraction caused no inhibition. The in vitro studies, however, showed inhibition of mitoses with both fractions. The malignant cells employed in vitro and in vivo were the Krebs-2 and Ehrlich carcinomas. The nonneoplastic cells tested in vitro were established cultures of epithelial-like cells from murine bone marrow and thymus, and corneal epithelium and peripheral blood in vivo.

Probiotics. Antistaphylococcal and antifibrinolytic activities of omega-amino-and omega-guanidinoalkanisulfonic acids

A series of omega-aminoalkanesulfonic acids (1-5) and omega-guanidinoalkanesulfonic acids (6-9) has been tested for antistaphylococcal and antifibrinolytic activities. Most of the omega-aminoalkanesulfonic acids and 6 produced better protection against Staphylococcus aureus infections in mice than gamma-aminobutyryl-L-histidine. Compound 4 was the best antistaphylococcal agent among the omega-aminoalkanesulfonic acids and compound 6 among the omega-guanidinoalkanesulfonic acids. Most of the omega-aminoalkanesulfonic acids have antifibrinolytic activity, while none of the omega-guanidinoalkanesulfonic acids has significant antifibrinolytic activity. Compound 4 possessed the highest antifibrinolytic activity which was equal to or greater than that of epsilon-aminohexanoic acid.

Offsetting toxicity of antineoplastic agents

PCO, a yeast extract, offsets at least in part the mitotic inhibitory effect of methotrexate and fluorouracil on bone marrow cells in vitro but increases the antimitotic activity of the drugs on ascites Krebs-2 carcinoma under similar conditions. In vivo, PCO enhances the action of methotrexate against the L-1210 lymphoid leukemia and does not interfere with the effectiveness of fluorouracil against the ascites Krebs-2 tumor.

Effects of omega-amino acids and related compounds on staphylococcal infections in mice: a combined prophylactic-therapeutic procedure

By a short-term combined prophylactic-therapeutic procedure, the following compounds were found to be active against staphylococcal infections in Swiss mice: gamma-aminobutyric acid, gamma-amino-beta-hydroxybutyric acid (GABOB), delta-amino-valeric acid (DAVA), epsilon-aminocaproic acid (EACA), trans-4-aminomethylcyclohexanecarboxylic acid (trans-AMCHA), taurine, and cysteic acid. Many of these compounds had displayed limited or no activity by a previously used prophylactic procedure. Although DAVA and GABOB were the most potent of the straight-chain omega-amino acids, trans-AMCHA displayed the greatest antistaphylococcic activity of the omega-amino acids thus far investigated. Homocarnosine (gamma-aminobutyrl histidine, which also was active by the prophylactic procedure) equalled trans-AMCHA in activity. Taurine was similar in potency to DAVA, and the activity of cysteic acid approximated that of EACA.

Prophylactic effects of gamma-aminobutyrylhistidine (homocarnosine) on experimental staphylococcal infections in mice

Prophylactic administration of the dipeptide homocarnosine induced a high degree of resistance to staphylococcal infections in Swiss albino mice. It expressed its antistaphylococcal properties 1 hr after administration, and this protection lasted for at least 1 month. Although 5 mg per animal (approximately 200 to 250 mg/kg) was routinely used in our studies, experiments showed that comparable results could be obtained with 1.5 mg per animal. Rechallenge experiments indicated that an active infection by itself may confer immunity up to 4 weeks, but an infection after treatment with homocarnosine gave complete immunity to reinfection for at least 2 months. Studies in vitro showed that homocarnosine had no effect on the growth or certain other characteristics (ability to ferment mannitol, liquefy gelatin, and to produce coagulase, deoxyribonuclease, and pigment) of S. aureus. It appears that resistance induced by this peptide is an indirect effect mediated by some nonimmunological host reaction. The possible involvement of homocarnosine, among other compounds, in the protective action of deproteinized beef extract against staphylococcal infections is suggested.

Activity of homocarnosine and other compounds against staphylococcal infections in mice

Homocarnosine and carnosine have been identified in bovine brain extracts which are effective in protecting mice against infections by Staphylococcus aureus. These peptides, as well as l-1-methylhistidine, beta-alanine, gamma-aminobutyric acid, delta-aminovaleric acid, epsilon-aminocaproic acid, 1-aminomethylcyclohexane-4-carboxylic acid, and anserine, were tested as prophylactic agents against S. aureus infections in C3H and Swiss mice. Histidine and methylhistidine were ineffective in preventing mortality in both mouse strains. Carnosine, anserine, and epsilon-aminocaproic acid were effective in C3H but not in Swiss mice. beta-Alanine and gamma-aminobutyric acid were weakly effective (C3H) or ineffective (Swiss). delta-Aminovaleric and 1-aminomethylcyclohexane-4-carboxylic acid (tested only in Swiss) were somewhat effective in early stages of the infection. Homocarnosine was the best compound and was highly effective in protecting both mouse strains against S. aureus infections by the testing procedure employed.