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

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 limite...

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Published in:British journal of dermatology (1951) 2023-04, Vol.188 (5), p.610-617
Main Authors: 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, Bachelez, Herve, Capon, Francesca, Contreras, Claudia R, De La Cruz, Claudia, Di Meglio, Paola, Gisondi, Paolo, Jullien, Denis, Lambert, Jo, Naldi, Luigi, Puig, Lluís, Spuls, Phyllis, Torres, Tiago, Warren, Richard B, Waweru, Hoseah, Galloway, James B, Griffiths, Christopher E M, Barker, Jonathan N, Norton, Sam, Smith, Catherine H, Mahil, Satveer K
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cited_by cdi_FETCH-LOGICAL-c326t-500d548f3f7446e78f506609887b1d70ee209158696c56b743ac43f83174ac833
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container_title British journal of dermatology (1951)
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creator 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
Bachelez, Herve
Capon, Francesca
Contreras, Claudia R
De La Cruz, Claudia
Di Meglio, Paola
Gisondi, Paolo
Jullien, Denis
Lambert, Jo
Naldi, Luigi
Puig, Lluís
Spuls, Phyllis
Torres, Tiago
Warren, Richard B
Waweru, Hoseah
Galloway, James B
Griffiths, Christopher E M
Barker, Jonathan N
Norton, Sam
Smith, Catherine H
Mahil, Satveer K
description 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. 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. 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. 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). 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 therap
doi_str_mv 10.1093/bjd/ljac144
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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. 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. 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. 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). 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.</description><identifier>ISSN: 0007-0963</identifier><identifier>EISSN: 1365-2133</identifier><identifier>DOI: 10.1093/bjd/ljac144</identifier><identifier>PMID: 36763806</identifier><language>eng</language><publisher>England</publisher><subject>Anxiety - epidemiology ; Anxiety - psychology ; COVID-19 - epidemiology ; Cross-Sectional Studies ; Depression - epidemiology ; Humans ; Pandemics ; Psoriasis - drug therapy ; Psoriasis - epidemiology</subject><ispartof>British journal of dermatology (1951), 2023-04, Vol.188 (5), p.610-617</ispartof><rights>The Author(s) 2022. 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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. 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. 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. Of 3980 participants from 77 countries, 1611 (40.5%) were prescribed a systemic immune-modifying therapy. 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epidemiology</topic><topic>Anxiety - psychology</topic><topic>COVID-19 - epidemiology</topic><topic>Cross-Sectional Studies</topic><topic>Depression - epidemiology</topic><topic>Humans</topic><topic>Pandemics</topic><topic>Psoriasis - drug therapy</topic><topic>Psoriasis - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Quirke-McFarlane, Sophia</creatorcontrib><creatorcontrib>Weinman, John</creatorcontrib><creatorcontrib>Cook, Emma S</creatorcontrib><creatorcontrib>Yiu, Zenas Z N</creatorcontrib><creatorcontrib>Dand, Nick</creatorcontrib><creatorcontrib>Langan, Sinead M</creatorcontrib><creatorcontrib>Bechman, Katie</creatorcontrib><creatorcontrib>Tsakok, Teresa</creatorcontrib><creatorcontrib>Mason, Kayleigh J</creatorcontrib><creatorcontrib>McAteer, Helen</creatorcontrib><creatorcontrib>Meynell, Freya</creatorcontrib><creatorcontrib>Coker, Bolaji</creatorcontrib><creatorcontrib>Vincent, Alexandra</creatorcontrib><creatorcontrib>Urmston, Dominic</creatorcontrib><creatorcontrib>Vesty, Amber</creatorcontrib><creatorcontrib>Kelly, Jade</creatorcontrib><creatorcontrib>Lancelot, Camille</creatorcontrib><creatorcontrib>Moorhead, Lucy</creatorcontrib><creatorcontrib>Barbosa, Ines A</creatorcontrib><creatorcontrib>Bachelez, Herve</creatorcontrib><creatorcontrib>Capon, Francesca</creatorcontrib><creatorcontrib>Contreras, Claudia R</creatorcontrib><creatorcontrib>De La Cruz, Claudia</creatorcontrib><creatorcontrib>Di Meglio, Paola</creatorcontrib><creatorcontrib>Gisondi, Paolo</creatorcontrib><creatorcontrib>Jullien, Denis</creatorcontrib><creatorcontrib>Lambert, Jo</creatorcontrib><creatorcontrib>Naldi, Luigi</creatorcontrib><creatorcontrib>Puig, Lluís</creatorcontrib><creatorcontrib>Spuls, Phyllis</creatorcontrib><creatorcontrib>Torres, Tiago</creatorcontrib><creatorcontrib>Warren, Richard B</creatorcontrib><creatorcontrib>Waweru, Hoseah</creatorcontrib><creatorcontrib>Galloway, James B</creatorcontrib><creatorcontrib>Griffiths, Christopher E M</creatorcontrib><creatorcontrib>Barker, Jonathan N</creatorcontrib><creatorcontrib>Norton, Sam</creatorcontrib><creatorcontrib>Smith, Catherine H</creatorcontrib><creatorcontrib>Mahil, Satveer K</creatorcontrib><creatorcontrib>PsoProtect study group</creatorcontrib><creatorcontrib>the PsoProtect study group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of dermatology (1951)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Quirke-McFarlane, Sophia</au><au>Weinman, John</au><au>Cook, Emma S</au><au>Yiu, Zenas Z N</au><au>Dand, Nick</au><au>Langan, Sinead M</au><au>Bechman, Katie</au><au>Tsakok, Teresa</au><au>Mason, Kayleigh J</au><au>McAteer, Helen</au><au>Meynell, Freya</au><au>Coker, Bolaji</au><au>Vincent, Alexandra</au><au>Urmston, Dominic</au><au>Vesty, Amber</au><au>Kelly, Jade</au><au>Lancelot, Camille</au><au>Moorhead, Lucy</au><au>Barbosa, Ines A</au><au>Bachelez, Herve</au><au>Capon, Francesca</au><au>Contreras, Claudia R</au><au>De La Cruz, Claudia</au><au>Di Meglio, Paola</au><au>Gisondi, Paolo</au><au>Jullien, Denis</au><au>Lambert, Jo</au><au>Naldi, Luigi</au><au>Puig, Lluís</au><au>Spuls, Phyllis</au><au>Torres, Tiago</au><au>Warren, Richard B</au><au>Waweru, Hoseah</au><au>Galloway, James B</au><au>Griffiths, Christopher E M</au><au>Barker, Jonathan N</au><au>Norton, Sam</au><au>Smith, Catherine H</au><au>Mahil, Satveer K</au><aucorp>PsoProtect study group</aucorp><aucorp>the PsoProtect study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey</atitle><jtitle>British journal of dermatology (1951)</jtitle><addtitle>Br J Dermatol</addtitle><date>2023-04-20</date><risdate>2023</risdate><volume>188</volume><issue>5</issue><spage>610</spage><epage>617</epage><pages>610-617</pages><issn>0007-0963</issn><eissn>1365-2133</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>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. 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. 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. 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). 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.</abstract><cop>England</cop><pmid>36763806</pmid><doi>10.1093/bjd/ljac144</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-2845-4384</orcidid><orcidid>https://orcid.org/0000-0003-4692-3794</orcidid><orcidid>https://orcid.org/0000-0002-1805-6278</orcidid><orcidid>https://orcid.org/0000-0002-2918-6481</orcidid><orcidid>https://orcid.org/0000-0002-1831-074X</orcidid><orcidid>https://orcid.org/0000-0003-1714-9963</orcidid><orcidid>https://orcid.org/0000-0001-9918-1144</orcidid><oa>free_for_read</oa></addata></record>
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identifier ISSN: 0007-0963
ispartof British journal of dermatology (1951), 2023-04, Vol.188 (5), p.610-617
issn 0007-0963
1365-2133
language eng
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source Oxford Journals
subjects Anxiety - epidemiology
Anxiety - psychology
COVID-19 - epidemiology
Cross-Sectional Studies
Depression - epidemiology
Humans
Pandemics
Psoriasis - drug therapy
Psoriasis - epidemiology
title Nonadherence to systemic immune-modifying therapy in people with psoriasis during the COVID-19 pandemic: findings from a global cross-sectional survey
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