Author: Fitzgerald, Kathryn C.; Mecoli, Christopher A.; Douglas, Morgan; Harris, Samantha; Aravidis, Berna; Albayda, Jemima; Sotirchos, Elias S.; Hoke, Ahmet; Orbai, Ana-Maria; Petri, Michelle; Christopher-Stine, Lisa; Baer, Alan N.; Paik, Julie J.; Adler, Brittany L.; Tiniakou, Eleni; Timlin, Homa; Bhargava, Pavan; Newsome, Scott D.; Venkatesan, Arun; Chaudhry, Vinay; Lloyd, Thomas E.; Pardo, Carlos A.; Stern, Barney J.; Lazarev, Mark; Truta, Brindusa; Saidha, Shiv; Chen, Edward S.; Sharp, Michelle; Gilotra, Nisha; Kasper, Edward K.; Gelber, Allan C.; Bingham, Clifton O.; Shah, Ami A.; Mowry, Ellen M.
Title: RISK FACTORS FOR INFECTION AND HEALTH IMPACTS OF THE COVID-19 PANDEMIC IN PEOPLE WITH AUTOIMMUNE DISEASES Cord-id: p8ndemgy Document date: 2021_2_5
ID: p8ndemgy
Snippet: BACKGROUND: People with autoimmune or inflammatory conditions who take immunomodulatory/suppressive medications may have a higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences. OBJECTIVE: Assess whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterize pandemic-associated changes to care. DESIGN: Longitudinal registry study PARTICIPANTS: 4666 individua
Document: BACKGROUND: People with autoimmune or inflammatory conditions who take immunomodulatory/suppressive medications may have a higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences. OBJECTIVE: Assess whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterize pandemic-associated changes to care. DESIGN: Longitudinal registry study PARTICIPANTS: 4666 individuals with autoimmune or inflammatory conditions followed by specialists in neurology, rheumatology, cardiology, pulmonology or gastroenterology at Johns Hopkins MEASUREMENTS: Periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare RESULTS: A total of 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medication exposure) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in multivariable models incorporating behavior and other potential confounders (OR: 1.43; 95%CI: 1.08, 1.89). Other medication classes were not associated with COVID-19 risk. Diabetes (OR: 1.72; 95%CI: 1.08, 2.73), cardiovascular disease (OR: 1.68; 95%CI: 1.24, 2.28), and chronic kidney disease (OR: 1.76; 95%CI: 1.04, 2.97) were each associated with higher odds of COVID-19. Pandemic-related disruption to care was common. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions. Individuals experiencing changes to employment or income were at highest odds of care disruption. LIMITATIONS: Results may not be generalizable to all patients with autoimmune or inflammatory conditions. Information was self-reported. CONCLUSIONS: Exposure to glucocorticoids may increase risk of COVID-19 in people with autoimmune or inflammatory conditions. Disruption to healthcare and related services was common. Those with pandemic-related reduced income may be most vulnerable to care disruptions.
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