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[Preprint]. 2021 Aug 9:2021.08.05.21261643.
doi: 10.1101/2021.08.05.21261643.

COVID-19 Outcomes Among Users of CD20 Inhibitors for Immune-Mediated Diseases: A Comparative Cohort Study

Naomi J Patel  1 , Kristin M D'Silva  1   2 , Tiffany Y-T Hsu  3 , Michael DiIorio  3 , Xiaoqing Fu  1   2 , Claire Cook  1   2 , Lauren Prisco  3 , Lily Martin  3 , Kathleen M M Vanni  3 , Alessandra Zaccardelli  3 , Yuqing Zhang  1   2 , Jeffrey A Sparks  3 , Zachary S Wallace  1   2
Affiliations

COVID-19 Outcomes Among Users of CD20 Inhibitors for Immune-Mediated Diseases: A Comparative Cohort Study

Naomi J Patel et al. medRxiv. .

Update in

Abstract

Objective: Patients with immune-mediated diseases treated with CD20 inhibitors may have worse COVID-19 outcomes due to impaired humoral immunity, but differences versus the general population are unknown.

Methods: We identified patients with immune-mediated diseases who received CD20 inhibitors within one year prior to the index date of PCR-confirmed COVID-19 between January 31, 2020, and January 31, 2021. Comparators with COVID-19 were matched up to 5:1 by age, sex, and PCR date. Hazard ratios (HRs) and 95% confidence intervals (CIs) for hospitalization, mechanical ventilation, and death in CD20 inhibitor users versus comparators were estimated using Cox regression.

Results: We identified 114 cases with COVID-19 who had received CD20 inhibitors for immune-mediated diseases (mean age 55 years, 70% female) and 559 matched comparators with COVID-19 (mean age 54 years, 70% female). CD20 inhibitor-treated cases had higher mortality (aHR 2.16; 95% CI: 1.03 to 4.54) than matched comparators. Risks of hospitalization (aHR 0.88; 95% CI: 0.62 to 1.26) and mechanical ventilation (aHR 0.82; 95% CI: 0.36 to 1.87) were similar. Similar trends were seen in analyses according to type of indication (e.g., rheumatic or neurologic disease) and duration of CD20 inhibitor use (<1 or ≥1 year), and after excluding patients with interstitial lung disease, cancer, and those on glucocorticoids prior to COVID-19 diagnosis.

Conclusions: Patients who received CD20 inhibitors for immune-mediated diseases prior to COVID-19 had higher mortality following COVID-19 than matched comparators, highlighting the urgent need to mitigate excess risks in CD20 inhibitor users during the ongoing pandemic.

Key messages: What is already known about this subject?: Patients with immune-mediated diseases treated with CD20 inhibitors may have worse COVID-19 outcomes than those treated with other immunomodulatory medications, but differences compared to the general population are unknown.What does this study add?: CD20 inhibitor-treated cases had over two-fold higher risk of mortality than matched general population comparators, although risks of hospitalization and mechanical ventilation were similar.How might this impact on clinical practice or future developments?: There is an urgent need for risk mitigation strategies, such as SARS-CoV-2 monoclonal antibodies or booster vaccinations, for patients with immune-mediated diseases treated with CD20 inhibitors during the ongoing COVID-19 pandemic.

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Conflict of interest statement

Competing interests: JAS reports research support from Bristol-Myers Squibb and consultancy fees from Bristol-Myers Squibb, Gilead, and Pfizer. ZSW reports research support from Bristol-Myers Squibb and Principia/Sanofi and consulting fees from Viela Bio and MedPace. All other authors report no competing interests.

Figures

Figure 1.
Figure 1.
Identification of CD20 inhibitor users with COVID-19. COVID-19, Coronavirus Disease 2019; RPDR, Research Patient Data Repository; PCR, Polymerase Chain Reaction, EHR, Electronic Health Record
See this image and copyright information in PMC

References

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