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. 2022 Feb 11;74(3):427-436.
doi: 10.1093/cid/ciab407.

Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases

Kathryn C Fitzgerald  1   2 , Christopher A Mecoli  3 , Morgan Douglas  1 , Samantha Harris  1 , Berna Aravidis  1 , Jemima Albayda  3 , Elias S Sotirchos  1 , Ahmet Hoke  1 , Ana-Maria Orbai  3 , Michelle Petri  3 , Lisa Christopher-Stine  3 , Alan N Baer  3 , Julie J Paik  3 , Brittany L Adler  3 , Eleni Tiniakou  3 , Homa Timlin  3 , Pavan Bhargava  1 , Scott D Newsome  1 , Arun Venkatesan  1 , Vinay Chaudhry  1 , Thomas E Lloyd  1 , Carlos A Pardo  1 , Barney J Stern  1 , Mark Lazarev  4 , Brindusa Truta  4 , Shiv Saidha  1 , Edward S Chen  5 , Michelle Sharp  5 , Nisha Gilotra  6 , Edward K Kasper  6 , Allan C Gelber  2   3 , Clifton O Bingham  3 , Ami A Shah  3 , Ellen M Mowry  1   2
Affiliations

Risk Factors for Infection and Health Impacts of the Coronavirus Disease 2019 (COVID-19) Pandemic in People With Autoimmune Diseases

Kathryn C Fitzgerald et al. Clin Infect Dis. .

Abstract

Background: People with autoimmune or inflammatory conditions taking immunomodulatory/suppressive medications may have higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences.

Methods: We included participants with autoimmune or inflammatory conditions followed by specialists at Johns Hopkins. Participants completed periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare. We assessed whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterized pandemic-associated changes to care and mental health.

Results: In total, 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medications) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in models incorporating behavior and other potential confounders (odds ratio [OR]: 1.43; 95% confidence interval [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 kidney disease (OR: 1.76; 95% CI: 1.04, 2.97) were associated with higher odds of COVID-19. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions therein, which disproportionately affected individuals experiencing changes to employment or income.

Conclusions: Glucocorticoid exposure 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.

Keywords: COVID-19; autoimmune disease; glucocorticoids; immune-modulating medications.

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Figures

Figure 1.
Figure 1.
Association between immune-modulating or suppressive medications* and risk of COVID-19. Odds ratios are adjusted for age, sex, race, SES, working on site, in person socialization habits (at baseline and during follow-up), smoking status, number of comorbidities, number of autoimmune or inflammatory condition diagnoses, and current smoking status. Abbreviations: CI, confidence interval; COVID-19, coronavirus disease 2019; DMD, disease modifying drug; SES, socioeconomic status; TNF, tumor necrosis factor.*For individuals medications included in each medication class, please refer to Supplementary Table 7.
Figure 2.
Figure 2.
Change in anxiety (left) and depression (right) occurring over the course of study follow-up. Mean differences are adjusted for age, sex, race, SES, working on site, in person socialization, number of comorbidities, number of autoimmune or inflammatory condition diagnoses, COVID-19 infection, change in employment due to COVID-19, and changes in ability to pay for disorder-associated costs. Abbreviations: COVID-19, coronavirus disease 2019; SES, socioeconomic status.
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