COVID-19 risk and outcomes in adult asthmatics treated with biologics or systemic corticosteroids : nationwide real-world evidence

Adir, Yochai; Humbert, Marc; Saliba, Walid

Background Managing severe asthma during the SARS-CoV-2 pandemic is challenging, particularly due to safety concerns regarding the use of systemic corticosteroids and biologics. Objectives To determine the association between biologics or systemic corticosteroids use with PCR positivity for SARS-CoV-2 and COVID-19 outcomes among asthmatic patients Methods We used the computerized database of Clalit Health Services, the largest healthcare provider in Israel, to identify all asthmatic adult patients who underwent PCR testing for SARS-CoV-2, between 1st of March 2020 and 7th December 2020. A cohort approach was used to assess the association between biologics use and steroids treatment and COVID-19 severity and 90-day mortality. Results Overall, 8,242 out of 80,602 tested asthmatics had positive PCR testing for SARS-CoV-2. Both biologics and systemic corticosteroids were not associated with increased risk of SARS-CoV-2 infection. Multivariate analyses revealed that biologics were not associated with a significant increased risk of moderate-severe COVID-19, nor with the composite endpoint of moderate-severe COVID-19 or all-cause mortality within 90 days. Chronic systemic corticosteroids use was associated with significant increased risk of all tested outcome. Recent (within the prior 120 days) systemic corticosteroids use, but not former use, was significantly associated with increased risk of both moderate-severe COVID-19 and the composite of moderate-severe COVID-19 or all-cause mortality. Conclusion Biologics approved for asthma and systemic corticosteroids are not associated with increased risk of SARS-CoV-2 infection. By contrast, systemic corticosteroids are independent risk factor for worst COVID-19 severity and all-cause mortality. Our findings underscore the risk of recent or current exposure to systemic corticosteroids in asthmatics infected with SARS-CoV-2.