Antecedent immunosuppressive therapy for immune-mediated inflammatory diseases in the setting of a COVID-19 outbreak

Veenstra, Jesse; Buechler, Connor R.; Robinson, Gabrielle; Chapman, Stephanie; Adelman, Madeline; Tisack, Aaron; Dimitrion, Peter; Todter, Erika; Kohen, Laurie L.; Lim, Henry W.

doi:10.1016/j.jaad.2020.07.089

Cited by 35 publications

(46 citation statements)

References 24 publications

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“… First author Country Continent Study design No. of patients Age (years) mean ± sd,/median(range) Sex Male Female Wallace et al [ 49 ] America North America cohort 31 61 (28–82) 9 22 Haberman et al [ 50 ] America North America case series 59 50 (25–73) 7 7 Gartshteyn et al [ 51 ] America North America case series 10 44.3 1 9 Fernandez-Ruiz et al [ 34 ] America North America cohort 41 47 ± 17.19 3 38 Veenstra et al [ 35 ] America North America cohort 77 – – – D'silva et al [ 52 ] America North America cohort 52 62.5 ± 15.1 16 36 Mathian et al [ 53 ] France Europe cohort 17 53.5 (26.6–69.2) 4 13 Aries et al [ 44 ] Germany Europe cross-sectional 30 – – – Ansarin et al [ 20 ] Ira...…”

Section: Resultsmentioning

confidence: 99%

“…The fatality rate was higher (0.113, 95% CI 0.098 to 0.13) than our study (0.07, 95% CI 0.03–0.11) and the COVID-19 GRA data (0.067). There were total 16 publications included in our meta-analysis but not in the study by Akiyama et al Three publications were missed [ [33] , [34] , [35] ], eight were excluded because only hospitalized patients were recruited [ 18 , [36] , [37] , [38] , [39] , [40] , [41] , [42] ], four published after 31st July 2020 when is the updated time of literature search by Akiyama et al [ 19 , 20 , 43 , 44 ]. Furthermore, we were not certain whether the cases were duplicated in published data and the COVID-19 GRA data.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes of COVID-19 in patients with rheumatic diseases: A systematic review and meta-analysis of global data

Cai

et al. 2021

Autoimmunity Reviews

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Objectives The impact of rheumatic diseases on COVID-19 infection remains poorly investigated. Here we performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 in patients with rheumatic diseases. Methods We systematically searched PubMed, Embase, Cochrane Library, Scopus and preprint database up to 29th August 2020, for publications with confirmed COVID-19 infection in patients with rheumatic diseases. The primary outcomes were the rates of hospitalization, oxygen support, intensive care unit (ICU) admission and death. A meta-analysis of effect sizes using the random-effects models was performed, and meta-regression analyses were performed to explore heterogeneity. The data from the COVID-19 Global Rheumatology Alliance physician registry (the COVID-19 GRA) was used as a reference. Results A total of 31 articles involving 1138 patients were included in this systematic review and meta-analysis. The publications were from Europe, Asia and North America, but none from other continents. The overall rates of hospitalization, oxygen support, ICU admission and fatality among COVID-19 infected patients with rheumatic diseases were 0.58 (95% confidence interval (CI) 0.48–0.67), 0.33 (95% CI 0.21–0.47), 0.09 (95% CI 0.05–0.15) and 0.07 (95% CI 0.03–0.11), respectively. The rate of oxygen support in Europe (0.48, 95% CI 0.4–0.57) was higher than that in other continents. Among all hospitalized patients, the rates of oxygen support, ICU admission and fatality were 0.61 (95% CI 0.48–0.73), 0.13 (95% CI 0.07–0.21) and 0.13 (95% CI 0.09–0.18), respectively. The fatality rate was highest in Europe (0.19, 95% CI 0.15–0.24). The fatality rate was higher both in this meta-analysis and the COVID-19 GRA (7.0% and 6.7%, respectively) than that (3.4%) in WHO database, although the age, gender and comorbidity were not matched. Conclusion Patients with rheumatic diseases remain vulnerable with substantial rates of severe outcomes and a geographic variation. More studies were urgently needed to elucidate the risk factors of severe outcomes in this population.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of COVID-19 in patients with rheumatic diseases: A systematic review and meta-analysis of global data

Cai

et al. 2021

Autoimmunity Reviews

View full text Add to dashboard Cite

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“…In a cohort-based on medical records from a health insurance in Detroit, USA, patients with IMID were analyzed according to COVID-19 status, admission rates, need for MV and dead. Those patients under glucocorticoid treatment had a 5-fold higher risk of admission, while patients under biologic DMARDs and specifically, those receiving anti-TNF had lower rates of admission [ 37 ]. In a national registry for patients with inflammatory rheumatic diseases in Germany, hospitalized patients were more often treated with glucocorticoids while bDMARDs were used less often [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center

Sarmiento-Monroy

Espinosa

Londoño

et al. 2021

Journal of Autoimmunity

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Background and aim There is increasing interest regarding SARS-CoV-2 infection in patients with autoimmune and immune-mediated inflammatory diseases (AI/IMID) with some discrepancies in different cohorts about their risk and outcomes. The aim was to describe a multidisciplinary cohort of patients with AI/IMID and symptomatic SARS-CoV-2 infection in a single tertiary center and analyze sociodemographic, clinical, and therapeutic factors associated with poor outcomes. Methods A retrospective observational study was conducted from the 1st of March until May 29th, 2020 in a University tertiary hospital in Barcelona, Spain. Patients with an underlying AI/IMID and symptomatic SARS-CoV-2 infection were identified in our local SARS-CoV-2 infection database. Controls (2:1) were selected from the same database and matched by age and gender. The primary outcome was severe SARS-CoV-2 infection, which was a composite endpoint including admission to the intensive care unit (ICU), need for mechanical ventilation (MV), and/or death. Several covariates including age, sex, and comorbidities among others were combined into a multivariate model having severe SARS-CoV-2 as the dependent variable. Also, a sensitivity analysis was performed evaluating AID and IMID separately. Results The prevalence of symptomatic SARS-CoV-2 infection in a cohort of AI/IMID patients was 1.3%. Eighty-five patients with AI/IMID and symptomatic SARS-CoV-2 were identified, requiring hospitalization in 58 (68%) cases. A total of 175 patients admitted for SARS-CoV-2 (58 with AI/IMID and 117 matched-controls) were analyzed. In logistic regression analysis, a significant inverse association between AI/IMID group and severe SARS-CoV-2 (OR 0.28; 95% CI 0.12–0.61; p = 0.001), need of MV (OR 0.20; IC 95% 0.05–0.71; p = 0.014), and ICU admission (OR 0.25; IC 95% 0.10–0.62; p = 0.003) was found. Conclusions Patients with AI/IMID who require admission for SARS-CoV-2 infection have a lower risk of developing severe disease, including the need to stay in the ICU and MV.

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“…Some small scale single center studies on patients with other immunological disorders and/or immunosuppressed reported possible higher mortality rate [ 26 ] and more frequent hospitalization for patients on glucocorticoids [ 27 , 28 ]. However, several other single center [ 29 ] and multi-center cohort studies did not find any definitive detrimental effects of IST in terms of risk of COVID-19 and related complications [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Immunosuppression in chronic autoimmune neurological disorders during the COVID-19 pandemic

Kovvuru

Nalleballe

Onteddu

et al. 2021

Journal of the Neurological Sciences

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To study the risk of acquiring Corona Virus Disease 2019 (COVID-19) and its outcomes in patients on immunosuppressive therapy (IST) for chronic autoimmune neuromuscular disorders (aNMD) and multiple sclerosis (MS). Methods: We used TriNetX, a global health collaborative clinical research platform collecting real-time electronic medical records data, which has one of the largest known global COVID-19 database. We included patients with chronic autoimmune neuromuscular disorders (aNMD) [myasthenia gravis (MG), inflammatory myositis, and chronic inflammatory neuropathies (CIN)] and MS, based on the International Classification of Disease-10 (ICD-10) coding for one year before January 20th, 2020. We examined the use of IST, rate of COVID-19, hospitalization, intubation, and mortality among the patients with aNMD and MS. Results: A total of 33,451 patients with aNMD and 42,899 patients with MS were included. Among them, 111 (0.33%) patients with aNMD and 115 patients (0.27%) with MS had COVID-19. About one third of them required hospitalization. IST did not appear to have a significant impact on overall infection risk in either group; however, risk of hospitalization for immunosuppressed patients with aNMD was higher (Odds ratio 2.86, p-value 0.011). Conclusions: IST use does not appear to make patients with aNMD and MS more vulnerable to COVID-19. IST may be continued during the pandemic, as previously suggested by expert opinion guidelines. However, it is important to consider individualizing immunotherapy regimens in some cases. Additional physician reported registry-based data is needed to further confirm these findings.

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Antecedent immunosuppressive therapy for immune-mediated inflammatory diseases in the setting of a COVID-19 outbreak

Cited by 35 publications

References 24 publications

Clinical outcomes of COVID-19 in patients with rheumatic diseases: A systematic review and meta-analysis of global data

Clinical outcomes of COVID-19 in patients with rheumatic diseases: A systematic review and meta-analysis of global data

A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center

Immunosuppression in chronic autoimmune neurological disorders during the COVID-19 pandemic

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