RISK FACTORS FOR INFECTION AND HEALTH IMPACTS OF THE COVID-19 PANDEMIC IN PEOPLE WITH AUTOIMMUNE DISEASES
Kathryn C Fitzgerald, ScD Christopher A Mecoli, MD, MHS Morgan Douglas, BS Samantha Harris, BS Berna Aravidis, BS Jemima Albayda, MD Elias S Sotirchos, MD Ahmet Hoke, Ana-Maria Orbai, MD, MHS Michelle Petri, MD, MPH Lisa Christopher-Stine, MD Alan N Baer, Julie J Paik, MD, MHS Brittany L Adler, MD Eleni Tiniakou, MD Homa Timlin, MD, MSc Pavan Bhargava, MD Scott D Newsome, Arun Venkatesan, PhD Vinay Chaudhry, MD Thomas E Lloyd, PhD Carlos A Pardo, MD Barney J Stern, MD Mark Lazarev, MD Brindusa Truta, MD, MAS Shiv Saidha, Edward S Chen, MD Michelle Sharp, MD, MHS Nisha Gilotra, MD Edward K Kasper, MD Allan C Gelber, Clifton O Bingham III, MD Ami A Shah, MD, MHS Ellen M Mowry
doi:10.1101/2021.02.03.21251069
Background People with autoimmune or inflammatory conditions who take immunomodulatory/suppressive medications may have a higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences.
Objective Assess whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterize pandemic-associated changes to care.
Design Longitudinal registry study Participants 4666 individuals with autoimmune or inflammatory conditions followed by specialists in neurology, rheumatology, cardiology, pulmonology or gastroenterology at Johns Hopkins Measurements Periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare
Results A total of 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medication exposure) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in multivariable models incorporating behavior and other potential confounders (OR: 1.43;
Author disclosures Dr. Fitzgerald has nothing to disclose.
References
Akiyama, Hamdeh, Micic, Sakuraba, Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis, Annals of the Rheumatic Diseases,
doi:10.1136/annrheumdis-2020-218946Bar-Or, Effect of ocrelizumab on vaccine responses in patients with multiple sclerosis: The VELOCE study, Neurology
Bartlett, Reliability and Validity of Selected PROMIS Measures in People with Rheumatoid Arthritis, PLOS ONE
Bernardinello, Prevalence of Depression in Sarcoidosis: a comparison with asthmatic and healthy controls, European Respiratory Journal
Bingham, Immunization responses in rheumatoid arthritis patients treated with rituximab: Results from a controlled clinical trial, Arthritis & Rheumatism
Core, R: A language and environment for statistical computing
Dixon, Immediate and delayed impact of oral glucocorticoid therapy on risk of serious infection in older patients with rheumatoid arthritis: a nested case-control analysis, Annals of the Rheumatic Diseases
Doran, Crowson, Pond, O'fallon, Gabriel, Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study, Arthritis Rheum
Emmi, SARS-CoV-2 infection among patients with systemic autoimmune diseases, Autoimmun Rev
Ethgen, Esteves, De, Bruyere, Reginster, What do we know about the safety of corticosteroids in rheumatoid arthritis?, Current Medical Research and Opinion
Fardet, Petersen, Nazareth, Common Infections in Patients Prescribed Systemic Glucocorticoids in Primary Care: A Population-Based Cohort Study, PLoS Med
Feinstein, Magalhaes, Richard, Audet, Moore, The link between multiple sclerosis and depression, Nature Reviews Neurology
Kind, Neighborhood socioeconomic disadvantage and 30-day rehospitalization: a retrospective cohort study, Ann. Intern. Med
Koçer, Cognition, depression, fatigue, and quality of life in primary Sjögren's syndrome: correlations, Brain Behav
Louapre, Clinical Characteristics and Outcomes in Patients With Coronavirus Disease 2019 and Multiple Sclerosis, JAMA Neurol
Luna, Infection Risks Among Patients With Multiple Sclerosis Treated With Fingolimod, Natalizumab, Rituximab, and Injectable Therapies, JAMA Neurol
Miller, Validating Neuro-QoL Short Forms and Targeted Scales with Persons who have Multiple Sclerosis, Mult Scler
Monti, Clinical course of COVID-19 in a series of patients with chronic arthritis treated with immunosuppressive targeted therapies, Annals of the Rheumatic Diseases
Peterson, The multifaceted impact of anxiety and depression on patients with rheumatoid arthritis, BMC Rheumatology
Pilkonis, Validation of the depression item bank from the Patient-Reported Outcomes Measurement Information System (PROMIS®) in a three-month observational study, J Psychiatr Res
Schalet, Clinical validity of PROMIS Depression, Anxiety, and Anger across diverse clinical samples, J Clin Epidemiol
Singh, Area deprivation and widening inequalities in US mortality, 1969-1998, Am J Public Health
Slimano, Cancer, immune suppression and Coronavirus Disease-19 (COVID-19): Need to manage drug safety (French Society for Oncology Pharmacy [SFPO] guidelines), Cancer Treatment Reviews
Sormani, An Italian programme for COVID-19 infection in multiple sclerosis, The Lancet Neurology
Sormani, Disease modifying therapies and Covid-19 severity in Multiple Sclerosis, Ann Neurol,
doi:10.1002/ana.26028Wijnands, Disease-modifying drugs for multiple sclerosis and infection risk: a cohort study, J Neurol Neurosurg Psychiatry
Zabalza, COVID-19 in multiple sclerosis patients: susceptibility, severity risk factors and serological response, European Journal of Neurology n/a
Zen, SARS-CoV-2 infection in patients with autoimmune rheumatic diseases in northeast Italy: A cross-sectional study on 916 patients, Journal of Autoimmunity
Zhang, The Influence of Depression on Quality of Life in Patients with Inflammatory Bowel Disease, Inflamm Bowel Dis
