Fig 2 - uploaded by Jesse J Veenstra
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Multivariate analysis of factors associated with hospital admission among patients with IMID treated with IS medication tested for COVID-19 by (A) IS therapeutic class and (B) IS monotherapy. *Any patient taking a medication from a therapeutic class was included in the respective group, regardless of additional medications taken. Bold values indicate statistical significance. y P \.05. z Patients taking multiple biologics and/or DMARDs were included in the multidrug therapy group. DMARD, Disease-modifying antirheumatic drug; GI, gastrointestinal; IS, immunosuppressive; TNF, tumor necrosis factor.
Source publication
Background
Finite clinical data and understanding of COVID-19 immunopathology has led to limited, opinion-based recommendations for management of immune-mediated inflammatory disease (IMID) patients on immunosuppressive (IS) therapeutics.
Objective
Determine if IS therapeutic type impacts COVID-19 risk among IMID patients.
Methods
We conducted a...
Contexts in source publication
Context 1
... whereas biologic therapy proved to be a negative predictor of admission (OR, 0.26; 95% CI, 0.066-0.95) (Fig 2, A). In turn, race was the only factor that proved able to predict COVID-19 status, with African American patients (OR, 2.8; 95% CI, 1.5-5.2) having greater odds of a positive test result (Supplemental Table VI, A). ...
Context 2
... patients receiving monotherapy were compared to one another to remove the confounding effects of additional IS medications, patients treated with TNF-a inhibitor monotherapy had significantly lower odds of admission (OR, 0.16; 95% CI, 0.032-0.72) (Fig 2, B). There were no other significant effects on outcomes of interest due to IS medications after multivariate analysis. ...
Similar publications
The safety of immunosuppressive treatment in patients with Immune‐Mediated Inflammatory Diseases (IMIDs) during the Coronavirus pandemic is questioned and it is utmost important for public health.
We searched studies trough MEDLINE/EMBASE database, including patient with IMID, undergoing immunosuppressive treatment with a positive diagnosis for SAR...
Background
Although recent studies have shown an association between obesity and adverse coronavirus disease 2019 (COVID-19) patient outcomes, there is a paucity in large studies focusing on hospitalized patients. We aimed to analyze outcomes associated with obesity in a large cohort of hospitalized COVID-19 patients.
Methods
We performed a retros...
Citations
... Por otro lado la artritis reumatoide (AR) también se logro asociar a la COVID-19 detallando ampliamente en informes de casos y estudios observacionales (13,14). Un estudio de cohorte observacional de COVID-19 realizado por Pablos et al., 2020 (15) investigó enfermedades inflamatorias preexistentes en pacientes. ...
Poco se conoce el impacto de la pandemia por COVID19, ya que se ha priorizado el disponer de vacunas y fármacos que ayuden a combatir esta enfermedad. Desconocemos la situación funcional de los sobrevivientes a COVID19 grave. Objetivo: Determinar el estado funcional de las personas mayores de 65 años de la Unidad de medicina familiar N9 que cursaron con COVID19 grave. Metodología: Se realizó un estudio transversal descriptivo, de mayo 2023 a junio del 2023. Se registró información que incluyó edad, género, mes y año en que padeció covid19, días de oxígeno suplementario. Se aplicó el índice de Lawton y Brody por entrevista a los adultos mayores de 65 años de edad o al cuidador primario. Resultados: La muestra fue de 95 pacientes. La mitad de los pacientes no estan alfabetizados y una alta proporción vive con sus hijos. El 6% cuenta con empleo temporal. Los casos se dieron en el 2020 y 2021. Solo la edad mostró asociación con menor puntuación en la escala de Lawton y Brody. La posibilidad de ser dependiente en menores de 80 años se estimó OR 0.17 (IC95% 0.06-0.46) p < 0.001. Conclusión: El estado funcional predominante es de dependencia moderada. Los adultos menores de 80 años tienen menor posibilidad de tener puntaje bajo en la escala de Lawton y Brody.
... 71,72 Immunocompromising therapies for IMIDs, such as TNF-α inhibitors, are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae and may even be associated with a lower risk of adverse COVID-19 outcomes. 73,74 In addition to the impact of immunemodulatory medications that were used in severe cases of COVID-19, on the developing, recurring, or improving the IMIDS, it is necessary to capture the trends at different stages of the pandemic. For example, there may be a surge in incidents as the post-COVID-19 era progresses and diagnoses return to normal levels. ...
... 71,72 Immunocompromising therapies for IMIDs, such as TNF-α inhibitors, are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae and may even be associated with a lower risk of adverse COVID-19 outcomes. 73,74 In addition to the impact of immunemodulatory medications that were used in severe cases of COVID-19, on the developing, recurring, or improving the IMIDS, it is necessary to capture the trends at different stages of the pandemic. For example, there may be a surge in incidents as the post-COVID-19 era progresses and diagnoses return to normal levels. ...
Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.
... 71,72 Immunocompromising therapies for IMIDs, such as TNF-α inhibitors, are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae and may even be associated with a lower risk of adverse COVID-19 outcomes. 73,74 In addition to the impact of immunemodulatory medications that were used in severe cases of COVID-19, on the developing, recurring, or improving the IMIDS, it is necessary to capture the trends at different stages of the pandemic. For example, there may be a surge in incidents as the post-COVID-19 era progresses and diagnoses return to normal levels. ...
Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.
... 71,72 Immunocompromising therapies for IMIDs, such as TNF-α inhibitors, are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae and may even be associated with a lower risk of adverse COVID-19 outcomes. 73,74 In addition to the impact of immunemodulatory medications that were used in severe cases of COVID-19, on the developing, recurring, or improving the IMIDS, it is necessary to capture the trends at different stages of the pandemic. For example, there may be a surge in incidents as the post-COVID-19 era progresses and diagnoses return to normal levels. ...
Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.
... 71,72 Immunocompromising therapies for IMIDs, such as TNF-α inhibitors, are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae and may even be associated with a lower risk of adverse COVID-19 outcomes. 73,74 In addition to the impact of immunemodulatory medications that were used in severe cases of COVID-19, on the developing, recurring, or improving the IMIDS, it is necessary to capture the trends at different stages of the pandemic. For example, there may be a surge in incidents as the post-COVID-19 era progresses and diagnoses return to normal levels. ...
Background
The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.
Methods
We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends.
Findings
In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR.
Interpretation
The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively.
... 71,72 Immunocompromising therapies for IMIDs, such as TNF-α inhibitors, are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae and may even be associated with a lower risk of adverse COVID-19 outcomes. 73,74 In addition to the impact of immunemodulatory medications that were used in severe cases of COVID-19, on the developing, recurring, or improving the IMIDS, it is necessary to capture the trends at different stages of the pandemic. For example, there may be a surge in incidents as the post-COVID-19 era progresses and diagnoses return to normal levels. ...
Background The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019.
... Some biological disease-modifying anti-rheumatic drugs (DMARDs) such as TNF-α inhibitors may reduce the risk of COVID-19 [59]. Along with low-dose prednisone, TNF-α inhibitors are associated with a lower rate of COVID-19 hospitalization and improved outcomes [54,60]. In general, neither a diagnosis of SARD nor the use of DMARDs has been conclusively associated with a higher risk of COVID-19 [55,61]. ...
... The use of rheumatic-based immunosuppressives targeting hypercytokinemia in patients with COVID-19 cytokine storm has put rheumatologists on the frontline of care in the critically ill COVID-19 patients in many centers. Rheumatologists now have to balance decisions on immunosuppressive therapy for patients in need of respiratory and cardiovascular support because of a severe viral infection, while still providing care to those with SARD and confirming that immunosuppressive therapy does not necessarily lead to higher risk of COVID-19 [52,55,60,61,64]. ...
The SARS-CoV-2 pandemic has had a significant impact on the healthcare field that resulted in changes to the way safe and effective medical care is delivered. The effects range from service disruption including ambulatory clinic closure due to both patient and provider concerns, to lack of capacity in hospital services. In rheumatology, there were other effects including viral infection-related autoantibody production, concerns about the use of systemic immunosuppression in the presence of an infectious pandemic and even concerns for viral infection-induced flares of rheumatic disease.
Coronavirus disease 2019 (COVID-19) led to the rapid adoption of innovative technologies that permitted the introduction and increased use of telemedicine via a number of platforms. Rapid discoveries and innovations led to the development of diagnostic and therapeutic agents in the management of COVID-19. Scientific advancement and discoveries around COVID-19 infection, symptoms, autoantibody production, chronic sequela and the repurposing of rheumatic immunosuppressive agents led to improved survival and an expanded role for the rheumatologist.
Rheumatologists may sometimes be involved in the diagnosis and management of the hospitalized COVID-19 patient. In the ambulatory clinic, a rheumatologist also helps to differentiate between symptoms of long COVID and those of systemic autoimmune rheumatic disease (SARD). Rheumatologists must also grapple with the concerns related to immunosuppressive therapy and the risk of COVID-19 infections. In addition, there are concerns around vaccine effectiveness in people with SARD and those on immunosuppressive medications. Although the SARS-CoV-2 pandemic and the effects on healthcare resulted in difficulties, both patients and providers have risen to the challenge. The long-term outcome of COVID-19 for the medical system and rheumatologists in particular is not yet fully understood and will need further study. This review concentrates on the changing role of the rheumatologists, improved understanding of rheumatic disease and immunosuppressive therapies in the wake of the pandemic and how this has led to an improvement in the care of patients with COVID-19.
... There were fewer patients on these therapies who required hospitalization or died compared to controls; however, this association was insignificant. 1 A study conducted during this period by Veenstra and coworkers also examined the relationship between TNFi and COVID-19, and found these medications to be associated with less severe disease. 2 Another study found MTX was associated with reduced mortality. 3 Since a much greater number of COVID-19 cases are now available for analysis, we re-examined the TriNetX database to clarify the relationship between COVID-19 severity and MTX or TNFi exposure. ...
... Consistent with the study by Veenstra and coworkers, our results suggest that patients on MTX and TNFi are not at increased risk of more severe COVID-19-related sequelae and that TNFi may be associated with less severe disease. 2 Ours are among the first to suggest MTX may also be associated with milder COVID-19. These findings continue to support ongoing use of TNFi and MTX without interruption due to fear of worse COVID-19 outcomes and also support the rationale for ongoing randomized trials testing TNFi and MTX as therapy for COVID-19. ...
... However, rates of SARS-CoV-2 infections in our cohort were comparable to the total Dutch population during 2020 (3.8 40 A few patients were admitted to the hospital and no complications occurred, which is in line with previous studies. [41][42][43][44][45][46] However, our data only stretches the first period of the pandemic in a singlecenter setting, and risk-mitigating behaviour could contribute to the low rates observed and lower risk of adverse COVID-19 outcomes. 47 This should be further investigated. ...
Background
Limited real-world studies are available comparing infection risk between biologics for psoriasis.
Objectives
The primary aim was to determine the differential effect of currently available biologics on the risk of respiratory tract infections (RTI) among psoriasis patients in a real-world setting. Secondary aims were to explore the differential risk of all types of serious infections (SI) between biologics and to provide an early overview of SARS-CoV-2 infections during the pre-vaccine era.
Methods
Crude incidence rates of RTI and SI were calculated per 100 patient-years (PY) per biologic using prospective BioCAPTURE data. Negative Binomial Regression modeling was used to explore the risk of RTI. Frailty Cox proportional hazards modeling was used to estimate hazard ratios for the risk of the first SI. Confounders adjusted for both models were selected by a directed acyclic graph. A post hoc exploratory analysis of SARS-CoV-2 infection incidence rates during 2020 was performed.
Results
We included 714 patients with 1325 treatment episodes (3607.7PY between 2005 and 2020), in which 2224 RTI and 63 SI occurred. Among RTI, 1.3% were serious. The crude incidence rates were 61.7 (95% confidence interval [CI]: 59.1–64.3) per 100PY for RTI, and 1.8 (95% CI: 1.4–2.2) per 100PY for SI. Confounder adjusted analyses showed no differential risk of RTI between adalimumab, etanercept, infliximab, ustekinumab, secukinumab, ixekizumab and guselkumab. For SI, no differential risk was found between biologics either. Extended single-center data showed 3.8 (95% CI: 2.2–6.1) SARS-CoV-2 infections per 100PY in 2020.
Conclusions
Confounder adjusted analyses showed no differential risks of RTI or SI between included biologics (adalimumab, etanercept, infliximab, ustekinumab, secukinumab, ixekizumab and guselkumab) in a prospective psoriasis patients cohort. In general, absolute numbers of all types of SI were low.
