## 3 Results
### Impact of SARS-CoV-2 Infection on Systemic Treatments in Psoriatic Patients  
All retrieved data are reported in Table 3.  
\begin{table}
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**Type of Study** **[Reference]** & **Outcomes** & **Number of Patients** & **Results** \\ \hline \multirow{6}{*}{Cohort study [40]} & \multirow{6}{*}{1830 patients} & \multirow{6}{*}{1830 patients} & COVID-19 infection, hospitalization, and mortality rates were not increased in psoriatic patients on beliogic treatment compared to the general population. & \multirow{6}{*}{1830 patients} & COVID-19 infection, hospitalization, and mortality rates were not increased in psoriatic patients on beliogic treatment compared to the general population. \\  & & & COVID-19 incidence rate 16: 9.7 (95\% CI 3.9-20.1) vs. 11.5 (95\% CI 11.4-11.7) per 100,000 person-months; Hospitalization IR: 6.5 (95\% CI 2.0-15.6) vs. 9.6 (95\% CI 9.4-9.7) per 10,000 person-months COVID-19-related death IR: 0 (95\% CI 10-10.4) vs. 1.16 (95\% CI 1.10-1.21) per 10,000 person-months \\ \hline \multirow{6}{*}{Global registry-based study [37]} & \multirow{6}{*}{1930 patients} & \multirow{6}{*}{374 clinician-reported patients} & The risk of COVID-19-related hospitalization is lower in patients treated with biologic drugs than in those treated with nonbeliogic systemic therapies. & \multirow{6}{*}{1830 patients} & Not statistically significant difference in COVID-19-related hospitalization between psoriatic patients using beliogics (\(n=9\)) and those not using beliogics (\(n=14\)) \\ \cline{1-1} \cline{3-3}  & & & \\ \cline{1-1}  
\begin{table}
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**Type of Study** [Reference] & **Outcomes** & **Number of Patients** & **Results** \\ \hline \hline IL17A/IL17R inhibitors & & & \\ \hline Clinical trial [43] & Safety and efficacy of izekizumab treatment for psoriatic patients with COVID-19 & recruiting & No evidence that IL-17 inhibitors increase the risk of SARS-CoV-2 infection or result in more severe COVID-19 & No evidence that IL-17 inhibitors increase the risk of SARS-CoV-2 infection or result in more severe COVID-19 \\ \hline \multirow{3}{*}{Case report [44]} & Safety of secukinumab treatment for psoriatic patients with COVID-19 & 2 psoriatic patients infected during izekizumab induction phase & 2.5. SARS-CoV-2 infection can be associated with increased, aberrant, and ineffective host immune response causing the acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) typical of the serious forms of COVID-19 [58; 59]. Five hyperinflammatory cell subtypes leading the inflammatory storm in lung injury, have been identified by [PERSON] et al. [60]: a subtype of macrophage (Macro_c2-CCL3L1), three subtypes of monocytes (Mono_c1- CD14-CCL3, Mono_c2-CD14-HLA-DPB1, and Mono_c3-CD14-VCAN), and neutrophils. These hyper-inflammatory subtypes produce specific cytokines, Macro_c2-CCL3L1, specifically expresses CCL8, CXCL10/11, and interleukin (IL)-6; Mono_c1-CD14-CCL3 expresses high levels of IL-19, CCL20, CXCL2, CXCL3, CCL3, CCL4, HBEGF, and tumor necrosis factor (TNF); and neutrophils express cytokines including TNFSF13B, CXCL8, FTH1, and CXCL16 [61]. Auto-inflammation driven by T cells, TNF-\(\alpha\), IL-23, and IL-17 underlies the pathogenic pathway of psoriasis [62]. Conventional systemic immunosuppression, small molecules, and biological agents are commonly used for therapeutic management of moderate to severe psoriasis [63]. Several studies have already shown that psoriatic patients treated with systemic or biological immunosuppression are exposed to a higher overall infection rate [40; 48; 59; 64; 65; 66; 40]. However, these studies did not consider the risk of virus infection separately [41] and none of them has considered the specific risk for coronavirusiridae family. Moreover, some data from literature have shown the safety of biologics in patients suffering from chronic viral infection as HIV [66].