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All Studies   Meta Analysis    Recent:   

Risk Factors for Infection and Health Impacts of the COVID-19 Pandemic in People with Autoimmune Diseases

Fitzgerald et al., medRxiv, doi:10.1101/2021.02.03.21251069
Feb 2021  
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Case 9% Improvement Relative Risk HCQ for COVID-19  Fitzgerald et al.  Prophylaxis Is pre-exposure prophylaxis with HCQ beneficial for COVID-19? Retrospective 4,666 patients in the USA No significant difference in cases c19hcq.org Fitzgerald et al., medRxiv, February 2021 FavorsHCQ Favorscontrol 0 0.5 1 1.5 2+
HCQ for COVID-19
1st treatment shown to reduce risk in March 2020
 
*, now with p < 0.00000000001 from 411 studies, recognized in 46 countries.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 75 treatments. c19hcq.org
Retrospective 4666 people with autoimmune or inflammatory conditions, showing HCQ adjusted risk of COVID-19 OR 0.91 [0.68-1.23]. Results are not adjusted for the significantly different risk of COVID-19 depending on the type and severity of autoimmune or inflammatory condition.
This study is excluded in the after exclusion results of meta analysis: not fully adjusting for the baseline risk differences within systemic autoimmune patients.
risk of case, 8.5% lower, RR 0.91, p = 0.54, treatment 65 of 1,072 (6.1%), control 200 of 3,594 (5.6%), adjusted per study, odds ratio converted to relative risk.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fitzgerald et al., 5 Feb 2021, retrospective, USA, preprint, 34 authors.
This PaperHCQAll
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.
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Chronic disease care has ' 'also changed for many patients, with uncertain downstream ' 'consequences.</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>Assess ' 'whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and ' 'characterize pandemic-associated changes to ' 'care.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>Longitudinal ' 'registry study</jats:p></jats:sec><jats:sec><jats:title>Participants</jats:title><jats:p>4666 ' 'individuals with autoimmune or inflammatory conditions followed by specialists in neurology, ' 'rheumatology, cardiology, pulmonology or gastroenterology at Johns ' 'Hopkins</jats:p></jats:sec><jats:sec><jats:title>Measurements</jats:title><jats:p>Periodic ' 'surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing ' 'and outcomes, social behaviors, and disruptions to ' 'healthcare</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>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; 95%CI: 1.08, 1.89). Other medication classes were not ' 'associated with COVID-19 risk. Diabetes (OR: 1.72; 95%CI: 1.08, 2.73), cardiovascular disease ' '(OR: 1.68; 95%CI: 1.24, 2.28), and chronic kidney disease (OR: 1.76; 95%CI: 1.04, 2.97) were ' 'each associated with higher odds of COVID-19. Pandemic-related disruption to care was common. ' 'Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative ' 'services, 975 (45.2%) reported disruptions. Individuals experiencing changes to employment or ' 'income were at highest odds of care ' 'disruption.</jats:p></jats:sec><jats:sec><jats:title>Limitations</jats:title><jats:p>Results ' 'may not be generalizable to all patients with autoimmune or inflammatory conditions. ' 'Information was ' 'self-reported.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Exposure ' 'to glucocorticoids may increase risk of COVID-19 in people with autoimmune or inflammatory ' 'conditions. Disruption to healthcare and related services was common. 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