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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"abstract": "<jats:title>ABSTRACT</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>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.</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. Those with pandemic-related reduced income may be most vulnerable to care disruptions.</jats:p></jats:sec>",
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