Covid-19 in Immune-Mediated Inflammatory Diseases — Case Series from New York

Haberman, Rebecca H.; Axelrad, Jordan E.; Chen, Alan; Castillo, Rochelle; Yan, Di; Izmirly, Peter; Neimann, Andrea L.; Adhikari, Samrachana; Hudesman, David; Scher, Jose U.

doi:10.1056/nejmc2009567

Cited by 402 publications

(494 citation statements)

References 3 publications

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“…In the absence of analyses from large claims databases, guidance on the management of immunosuppressive therapies during the COVID-19 pandemic remains mostly supported by low-quality evidence (32)(33)(34). Preliminary observational studies appear overall reassuring on the incidence and clinical course of COVID-19 in immunosuppressed patients [32][33][34][35][36][37]. However, different classes of immunomodulating agents, often used in combination in patients with IMIDs, may have a different and even opposite impact on SARS-CoV-2 infection [38][39][40][41], which is at present undetermined.…”

Section: Introductionmentioning

confidence: 99%

Impact of Corticosteroids and Immunosuppressive Therapies on Symptomatic SARS-CoV-2 Infection in a Large Cohort of Patients with Chronic Inflammatory Arthritis

Favalli

Bugatti

Klersy

et al. 2020

Preprint

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Background: Prevalence and outcomes of Coronavirus Disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis.Methods: The study was conducted in the arthritis outpatient clinic at two large Academic Hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of Severe Acute Respiratory Syndrome-Coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25th February to 20th April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 incidence was evaluated. Results: The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04-1.44] to 3.20 [1.97-5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18-1.21] to 0.47 [0.46-0.48]). No independent effects of csDMARDs were observed.Conclusions: During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection.Trial registration: retrospectively registered

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Section: Introductionmentioning

confidence: 99%

Impact of Corticosteroids and Immunosuppressive Therapies on Symptomatic SARS-CoV-2 Infection in a Large Cohort of Patients with Chronic Inflammatory Arthritis

Favalli

Bugatti

Klersy

et al. 2020

Preprint

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“…In our cohort, the high rate of patients with metabolic syndrome can partly be explained by a high rate of systemic corticosteroid therapy, i.e. 85% of COVID-19 patients and 75% of hospitalized patients compared to 9% and 29% respectively in the study by Haberman et al (18). Our results are consistent with those of previous studies showing that the use of systemic corticosteroids is a risk factor for a severe course of COVID-19, particularly in inflammatory bowel diseases (19).…”

Section: Discussionmentioning

confidence: 57%

“…The prevalence of diabetic patients in our sarcoidosis cohort reached 23% for patients with COVID-19 and 50% for hospitalized patients, compared to 6% and 14% respectively in a New York series reporting patients with an immune-mediated inflammatory disease COVID-19 positive (9). The body mass index of sarcoidosis patients is also particularly high (10).…”

Section: Discussionmentioning

confidence: 73%

Prevalence and clinical features of COVID-19 in a large cohort of 199 patients with sarcoidosis

Marques¹,

Lefevre²,

Barmo³

et al. 2020

Preprint

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Objective: To investigate the prevalence, clinical features and outcomes of coronavirus disease 2019 (COVID-19) among sarcoidosis patients. Methods: We retrospectively collected features of COVID-19 in a cohort of patients with sarcoidosis followed in a single tertiary university hospital. Results: Among 199 sarcoidosis patients [mean age 58.8 (±14) years, 86 (43.2%) men], 26 (13%) were diagnosed with COVID-19 [definite (n=7), probable (n=12) and possible (n=7)]. Twenty-four out of 26 patients (92%) had at least one comorbidity, and 11/26 (42%) had two or more comorbidities. Demographic and clinical features of COVID-19 positive patients were similar to those of COVID-19 negative patients. The administration of hydroxychloroquine or immunosuppressant was not associated with the occurrence or the severity of COVID-19. Four out of 26 (15.4%) COVID-19 positive patients required admission to hospital and two of them died. Hospitalized patients [mean age of 61 (±11.5) years] were receiving higher doses of long term treatment with corticosteroids than non-hospitalized patients; 4/4 had pulmonary and 2/4 cardiac involvement of sarcoidosis, and all one or more comorbidity. Conclusion: The prevalence of COVID-19 in sarcoidosis is slightly higher to that of the general population. Almost half of the COVID-19 positive patients have two or more comorbidities and about 15% present a severe course.

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“…We supposed that the different frequency of asymptomatic COVID-19, lower frequency of fever, and higher frequency of uncommon symptoms in women with endometriosis in the present study can be attributed to the immune interactions during endometriosis (15). It has been previously suggested that patients with immune-mediated in ammatory diseases, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, psoriasis, and in ammatory bowel disease have different disease characteristics of COVID-19 (36). The immune system should ght against SARS-CoV-2 by activation of cellular and innate in ammatory responses (37), which may be altered by the underlying immune dysfunction in the patient (38) and hence cause the different response of women with endometriosis to COVID-19, as shown in the present study.…”

Section: Discussionmentioning

confidence: 58%

Does Endometriosis Increase Susceptibility to COVID–19 Infections? A case-control study in Women of Reproductive Age

Moazzami

Chaichian

Samie

et al. 2020

Preprint

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Background: In today’s world, coronavirus disease 2019 (COVID–19) is the most critical health problem and research is continued on studying the associated factors. But it is not clear whether endometriosis increases the risk of COVID–19.Methods: Women who referred to the gynecology clinic were evaluated and 507 women with endometriosis (case group) were compared with 520 women without endometriosis (control group). COVID–19 infection, symptoms, exposure, hospitalization, isolation, H1N1 infection and vaccination, and past medical history of the participants were recorded and compared between the groups using IBM SPSS Statistics for Windows version 21.Results: Comparison between the groups represent COVID–19 infection in 3.2% of the case group and 3% of the control group (P=.942). The control group had a higher frequency of asymptomatic infection (95.7% vs. 94.5%; P<.001) and fever (1.6% vs. 0%; P=.004), while the frequency of rare symptoms was more common in the case group (P<.001). The average disease period was 14 days in both groups (P=.694). COVID–19 infection was correlated with close contact (r=.331; P<.001 in the case group and r=.244; P<.001 in the control group), but not with the history of thyroid disorders, H1N1 vaccination, traveling to high-risk areas, and social isolation (P>.05).Conclusion: Endometriosis does not increase the susceptibility to COVID–19 infections, but alters the manifestation of the disease. The prevalence of the disease may depend on the interaction between the virus and the individual’s immune system but further studies are required in this regard.

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Covid-19 in Immune-Mediated Inflammatory Diseases — Case Series from New York

Cited by 402 publications

References 3 publications

Impact of Corticosteroids and Immunosuppressive Therapies on Symptomatic SARS-CoV-2 Infection in a Large Cohort of Patients with Chronic Inflammatory Arthritis

Impact of Corticosteroids and Immunosuppressive Therapies on Symptomatic SARS-CoV-2 Infection in a Large Cohort of Patients with Chronic Inflammatory Arthritis

Prevalence and clinical features of COVID-19 in a large cohort of 199 patients with sarcoidosis

Does Endometriosis Increase Susceptibility to COVID–19 Infections? A case-control study in Women of Reproductive Age

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