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Clinical Trial
. 2021 Mar:118:102613.
doi: 10.1016/j.jaut.2021.102613. Epub 2021 Feb 12.

Coronavirus disease 2019, immune-mediated inflammatory diseases and immunosuppressive therapies - A Danish population-based cohort study

Mohamed Attauabi  1 , Jakob Benedict Seidelin  2 , Oluf Krautwald Felding  3 , Mads Damsgaard Wewer  3 , Laura Kirstine Vinther Arp  3 , Melek Zahra Sarikaya  3 , Alexander Egeberg  4 , Nora Vladimirova  5 , Flemming Bendtsen  3 , Johan Burisch  3
Affiliations
Clinical Trial

Coronavirus disease 2019, immune-mediated inflammatory diseases and immunosuppressive therapies - A Danish population-based cohort study

Mohamed Attauabi et al. J Autoimmun. 2021 Mar.

Abstract

Background: Limited data exist regarding the disease course of coronavirus disease 2019 (COVID-19) and its relationship with immunosuppressants among patients with immune-mediated inflammatory diseases (IMIDs). Therefore, this study aims to investigate the association between COVID-19, frequent rheumatological, dermatological, gastrointestinal, and neurological IMIDs and immunosuppressants.

Methods: We conducted a Danish population-based cohort study including all residents living within Capital Region of Denmark and Region Zealand from January 28th, 2020 until September 15th, 2020 with the only eligibility criterion being a test for SARS-CoV-2 via reverse transcription-polymerase chain-reaction. Main outcomes included development of COVID-19, COVID-19-related hospitalization and mortality.

Results: COVID-19 was less common among patients with IMIDs than the background population (n = 328/20,513 (1.60%) and n = 10,792/583,788(1.85%), p < 0.01, respectively). However, those with IMIDs had a significantly higher risk of COVID-19-related hospitalization (31.1% and 18.6%, p < 0.01, respectively) and mortality (9.8% and 4.3%, p < 0.01, respectively), which were associated with patients older than 65 years, and presence of comorbidities. Furthermore, systemic steroids were independently associated with a severe course of COVID-19 (Odds ratio (OR) = 3.56 (95%CI 1.83-7.10), p < 0.01), while biologic therapies were associated with a reduced risk hereof (OR = 0.47 (95%CI 0.22-0.95), p = 0.04). Patients suspending immunosuppressants due to COVID-19 had an increased risk of subsequent hospitalization (OR = 3.59 (95%CI 1.31-10.78), p = 0.02).

Conclusion: This study found a lower occurrence, but a more severe disease course, of COVID-19 among patients with IMIDs, which was associated with the use of systemic steroids for IMIDs and suspension of other immunosuppressants. This study emphasizes the importance of weighing risks before suspending immunosuppressants during COVID-19.

Keywords: Autoimmune diseases; COVID-19; Epidemiology; Immune-mediated inflammatory diseases; Immunosuppressive agents; Population-based.

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Conflict of interest statement

MA: None.

JBS: Research grants from Takeda and the Capital Region Denmark, national coordinator of studies from AbbVie, Arena Pharmaceuticals, Eli Lilly, and Boehringer Ingelheim. None of these pertain to the research submitted here.

OKF, MDW, LKVA, and MZS: None.

AE: Research funding from Pfizer, Eli Lilly, Novartis, AbbVie, Janssen Pharmaceuticals, the Danish National Psoriasis Foundation, the Simon Spies Foundation, and the Kgl Hofbundtmager Aage Bang Foundation, and honoraria as consultant and/or speaker from AbbVie, Almirall, Leo Pharma, Samsung Bioepis Co., Ltd., Pfizer, Eli Lilly and Company, Novartis, Galderma, Dermavant, UCB, Mylan, Bristol-Myers Squibb, and Janssen Pharmaceuticals.

NV: Honoraria as speaker from MSD. These did not pertain to the research submitted here.

FB: Grants from Ferring and Tillotts. These did not pertain to the research submitted here.

JB: Personal fees from AbbVie, Janssen-Cilag, Celgene, Samsung Bioepis, and Pfizer; grants and personal fees from Takeda, MSD, and Tillots Pharma; grants from Novo Nordisk Foundation and Bristol Meyers Squibb. None of these pertain to the research submitted here.

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