RISK FACTORS FOR INFECTION AND HEALTH IMPACTS OF THE COVID-19 PANDEMIC IN PEOPLE WITH AUTOIMMUNE DISEASES

  1. Kathryn C. Fitzgerald
  2. Christopher A. Mecoli
  3. Morgan Douglas
  4. Samantha Harris
  5. Berna Aravidis
  6. Jemima Albayda
  7. Elias S. Sotirchos
  8. Ahmet Hoke
  9. Ana-Maria Orbai
  10. Michelle Petri
  11. Lisa Christopher-Stine
  12. Alan N. Baer
  13. Julie J. Paik
  14. Brittany L. Adler
  15. Eleni Tiniakou
  16. Homa Timlin
  17. Pavan Bhargava
  18. Scott D. Newsome
  19. Arun Venkatesan
  20. Vinay Chaudhry
  21. Thomas E. Lloyd
  22. Carlos A. Pardo
  23. Barney J. Stern
  24. Mark Lazarev
  25. Brindusa Truta
  26. Shiv Saidha
  27. Edward S. Chen
  28. Michelle Sharp
  29. Nisha Gilotra
  30. Edward K. Kasper
  31. Allan C. Gelber
  32. Clifton O. Bingham
  33. Ami A. Shah
  34. Ellen M. Mowry
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Abstract

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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