Abstract: 【Abstract】 Objective To investigate changes in disease status and their influencing factors in patients with moderate to severe plaque psoriasis treated with biologics during the coronavirus disease 2019 （COVID-19） pandemic. Methods Through printed or electronic questionnaires during February 10th - 20th, 2023, data were collected from patients with moderate to severe plaque psoriasis treated with biologics in Henan Provincial People′s Hospital from June 2019 to January 2023, and changes in the disease condition during the COVID-19 pandemic were investigated. The t test or chi-square test was used for comparisons between groups, univariate analysis and multivariate logistic regression analysis were conducted to investigate the factors contributing to the exacerbation of psoriasis, and stratified analysis was employed to evaluate the disease progression among the patients receiving different biologic therapies following treatment delays. Results A total of 177 patients with moderate to severe plaque psoriasis were collected, including 115 males and 62 females; they were aged 6 - 83 （38.69 ± 14.18） years, with disease duration of 1 - 50 （13.48 ± 9.70） years. Among the patients, 74 （41.81%） experienced psoriasis exacerbation, 154 （87.01%） developed COVID-19, and 90 （50.85%） experienced delays in psoriasis treatment due to the pandemic. The results of univariate analysis indicated significant associations of psoriasis exacerbation with treatment delays, irregular treatment before the pandemic, and incomplete clearance of skin lesions （P < 0.001 or 0.05）, while no correlations were observed between psoriasis exacerbation and COVID-19 or gender （both P > 0.05）. Multivariate logistic regression analysis demonstrated that psoriasis exacerbation was associated with treatment delays due to COVID-19 （OR = 3.34, 95% CI: 1.35 - 8.22, P = 0.009） and incomplete clearance of skin lesions （OR = 3.10, 95% CI: 1.28 - 7.50, P = 0.012）, but not associated with irregular treatment before the pandemic （P = 0.130）. Among the patients treated with adalimumab, secukinumab, ustekinumab, and ixekizumab, those experiencing treatment delays exhibited higher rates of psoriasis exacerbation than those without treatment delays （all P < 0.05）. Conclusion Patients with moderate to severe plaque psoriasis undergoing biologic therapy are prone to disease exacerbation when treatment is delayed due to COVID-19, especially those with incomplete lesion clearance.

Key words: Psoriasis, Biological agents, Coronavirus infections, Cytokines, Regression analysis, Disease severity