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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 (PsoProtect Me), 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. [ABSTRACT FROM AUTHOR]

This finding supports current limited data on vaccine hesitancy among patients with psoriasis.6 In contrast to a prior report in psoriasis,6 but in keeping with general population trends,4 hesitancy was more prominent among younger people. PsoProtect I Me i was updated 1 year following its launch to include COVID-19 vaccine hesitancy and questions regarding access to care, hence the current sample may not be representative of the original larger sample.7 Taken together, these data indicate that only a minority of individuals with psoriasis have vaccine hesitancy hence our findings are promising for current and future COVID-19 vaccine uptake. (d) Association between disrupted access to psoriasis care and COVID-19 vaccine hesitancy. gl In an unadjusted logistic regression model, strongly agreeing that psoriasis care was disrupted, was associated with vaccine hesitancy [compared with strongly disagreeing; odds ratio (OR) 2-97, 95% confidence interval (CI) 1-23-7-13, I P i = 0-015]. Dear Editor, COVID-19 vaccines protect against severe COVID-19 outcomes; however, many individuals remain unvaccinated.1,2 Vaccine hesitancy (delayed acceptance or refusal of vaccination despite service availability) threatens public health. [Extracted from the article]