tetano
Editor, Senior Moderator
Arthritis Res Ther
. 2020 Dec 30;22(1):290.
doi: 10.1186/s13075-020-02395-6.
Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis
Ennio Giulio Favalli[SUP] 1 [/SUP], Serena Bugatti[SUP] 2 3 [/SUP], Catherine Klersy[SUP] 4 [/SUP], Martina Biggioggero[SUP] 5 [/SUP], Silvia Rossi[SUP] 2 [/SUP], Orazio De Lucia[SUP] 5 [/SUP], Francesca Bobbio-Pallavicini[SUP] 2 [/SUP], Antonella Murgo[SUP] 5 [/SUP], Silvia Balduzzi[SUP] 2 [/SUP], Roberto Caporali[SUP] 5 6 [/SUP], Carlomaurizio Montecucco[SUP] 2 3 [/SUP]
Affiliations
Abstract
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 25 February to 20 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 development 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, age, sex, and comorbidities 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. Not applicable.
Keywords: Biologic drugs; COVID-19; Glucocorticoids; Rheumatic diseases; SARS-CoV-2.
. 2020 Dec 30;22(1):290.
doi: 10.1186/s13075-020-02395-6.
Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis
Ennio Giulio Favalli[SUP] 1 [/SUP], Serena Bugatti[SUP] 2 3 [/SUP], Catherine Klersy[SUP] 4 [/SUP], Martina Biggioggero[SUP] 5 [/SUP], Silvia Rossi[SUP] 2 [/SUP], Orazio De Lucia[SUP] 5 [/SUP], Francesca Bobbio-Pallavicini[SUP] 2 [/SUP], Antonella Murgo[SUP] 5 [/SUP], Silvia Balduzzi[SUP] 2 [/SUP], Roberto Caporali[SUP] 5 6 [/SUP], Carlomaurizio Montecucco[SUP] 2 3 [/SUP]
Affiliations
- PMID: 33380344
- DOI: 10.1186/s13075-020-02395-6
Abstract
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 25 February to 20 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 development 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, age, sex, and comorbidities 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. Not applicable.
Keywords: Biologic drugs; COVID-19; Glucocorticoids; Rheumatic diseases; SARS-CoV-2.