Association of inhaled and systemic corticosteroid use with Coronavirus Disease 2019 (COVID-19) test positivity in patients with chronic pulmonary diseases

Abstract

Background The effects of chronic inhaled and systemic corticosteroids use on COVID-19 susceptibility and severity are unclear. Since many patients with chronic pulmonary diseases rely on corticosteroids to control disease, it is important to understand the risks of their use during the pandemic. We aim to study if the use of inhaled or systemic corticosteroids affects the likelihood of developing COVID-19 infection. Methods We used the National Jewish Health electronic medical record research database to identify a cohort of all subjects who were tested for suspected COVID-19 between March 11 - June 23, 2020. Testing results, medication use, and comorbidities were obtained from the medical record. Following a comparison of different propensity score weighting methods, overlap propensity score weighting was used to analyze the association between medication use and COVID-19 diagnosis. Results The cohort consisted of 928 patients, of which 12% tested positive. The majority (66%) of patients had a history of chronic pulmonary diseases. There was no significant association between inhaled corticosteroid use and testing positive for COVID-19. Interestingly, systemic corticosteroid use was associated with a lower odds ratio (0.95, 95% CI: 0.91–0.99) of testing positive for COVID-19. Similar results were noted when the analysis was restricted to those with any chronic pulmonary diseases, with asthma or with chronic obstructive pulmonary disease (COPD). Conclusions Our study supports the recommendation that patients with chronic pulmonary diseases, including asthma and COPD who require treatment with either inhaled or systemic corticosteroids, should continue their use during the COVID-19 pandemic.

DrugWAS: Leveraging drug-wide association studies to facilitate drug repurposing for COVID-19

“…The method has been shown to achieve high performance under different configurations, 37,38 and, recently, it has been successfully used in estimating the relationship between use of specific drugs and COVID-19 outcomes. [39][40][41] Specifically, the propensity score for being exposed to a drug was estimated by a multivariable logistic regression model using age, sex, race, ethnicity, and weighted Elixhauser comorbidity score. Using the estimated propensity score, a weighted multivariable logistic regression was performed to estimate the effect of drug exposure on both primary and secondary outcomes, where each patient was weighted with the probability of the patient being assigned to the opposite exposure group.…”

DrugWAS: Drug‐wide Association Studies for COVID‐19 Drug Repurposing

“…The method has been shown to achieve high performance under different configurations, 23 and, recently, it has been successfully used in estimating the relationship between use of specific drugs and COVID‐19 outcomes. 24 , 25 Specifically, the propensity score for being exposed to a drug was estimated by a multivariable logistic regression model using age, sex, race, ethnicity, and weighted Elixhauser comorbidity score. Using the estimated propensity score, a weighted multivariable logistic regression (adjusted for drug exposure, age, sex, race, ethnicity, and weighted Elixhauser comorbidity score) was performed to estimate the effect of drug exposure on both primary and secondary outcomes, where each patient was weighted with the probability of the patient being assigned to the opposite exposure group.…”

Inhaled corticosteroids do not adversely impact outcomes in COVID-19 positive patients with COPD: An analysis of Cleveland Clinic’s COVID-19 registry

“…The risk was reduced although not normalized when adjusted for comorbidities and demographic factors [ 62 ]. Finally, a recent retrospective observational study from Colorado, USA, reported no effect of ICS on rates of testing positive for SARS-CoV-2 [ 25 ]. The authors did report a lower rate of SARS-CoV-2 positivity in patients on systemic corticosteroid therapy.…”

“…Currently there are very few studies analyzing the safety and efficacy of ICS in patients with COPD in regards to COVID-19 infection rate or disease severity [ 23 – 25 ]. We hypothesized that amongst patients with COPD who develop COVID-19, those who are on ICS therapy will have similar inpatient outcomes, mortality and healthcare utilization as those who are not on ICS.…”