Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Oct;3(10):e724-e736.
doi: 10.1016/S2665-9913(21)00247-2. Epub 2021 Aug 27.

COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses

Filippo Fagni  1   2 , David Simon  1   2 , Koray Tascilar  1   2 , Verena Schoenau  1   2 , Michael Sticherling  2   3 , Markus F Neurath  2   4 , Georg Schett  1   2
Affiliations
Review

COVID-19 and immune-mediated inflammatory diseases: effect of disease and treatment on COVID-19 outcomes and vaccine responses

Filippo Fagni et al. Lancet Rheumatol. 2021 Oct.

Abstract

At the beginning of the COVID-19 pandemic, patients with immune-mediated inflammatory diseases were considered to be at high risk for SARS-CoV-2 infection and the development of severe COVID-19. Data collected over the past year, however, suggest that a diagnosis of inflammatory arthritis, psoriasis, or inflammatory bowel diseases does not increase risk for SARS-CoV-2 infection or severe COVID-19 compared with people without these diseases. Furthermore, substantial data suggest that certain medications frequently used in patients with immune-mediated inflammatory diseases, in particular cytokine inhibitors, might even lower the risk for severe COVID-19. Conversely, glucocorticoids and potentially B-cell-depleting treatments seem to worsen COVID-19 outcomes. Additionally, the first data on SARS-CoV-2 vaccination in patients with these diseases suggest that tolerability of vaccination in patients with immune-mediated inflammatory diseases is good, although the immune response to vaccination can be somewhat reduced in this patient group, particularly those taking methotrexate or CD20-targeted treatment.

PubMed Disclaimer

Conflict of interest statement

KT reports honoraria for lectures from UCB and Gilea. MS reports honoraria for lectures from Abbvie, Amgen, Celgene, Hexal, Jannsen, Leo, Lilly, Pfizer, Merck Sharpe & Dome, Mundipharma, Novartis, Sanofi, UCB; support for attending meetings from Abbvie, Celgene, Hexal, Jannsen, Leo, Lilly, Pfizer, Novartis, UCB; and participation advisory boards from Abbvie, Amgen, Celgene, Hexal, Jannsen, Leo, Lilly, Pfizer, Merck Sharpe & Dome, Mundipharma, Novartis, Sanofi, and UCB. MN reports consulting fees from Boehringer Ingelheim, IFM Therapeutics, Sterna Biologicals, Pentax; and honoraria for lectures from Abbvie, Amgen, Celgene, Falk, Janssen, Merck Sharpe & Dome, and Takeda. GS reports honoraria for lectures from Abbvie, Bristol Myers Squibb, Eli Lilly, Gilead, Janssen, Novartis, Pfizer, UCB; and consulting fees from Eli Lilly, Janssen, Novartis.

Figures

Figure 1
Figure 1
Factors with immune-mediated inflammatory diseases that influence the risk for the development of severe COVID-19 ARDS=acute respiratory distress syndrome. IBD=inflammatory bowel disease. IMID=immune-mediated inflammatory diseases. TNF=tumour necrosis factor. IL=interleukin. GM-CSF=granulocyte-macrophage colony-stimulating factor. *Comorbidities such as cardiovascular, pulmonary, and metabolic diseases.
Figure 2
Figure 2
Relative risk of SARS-CoV-2 infection and COVID-19-related hospitalisation and death in patients with immune-mediated inflammatory disease receiving glucocorticoids compared with patients with immune-mediated inflammatory disease not receiving glucocorticoids Significant results (p<0·05) are reported in red, non-significant results are reported in grey. Only studies that reported relative risk values for glucocorticoids exposure were included., , , , , ,
Figure 3
Figure 3
Relative risk of SARS-CoV-2 infection and COVID-19-related hospitalisation, ICU admission, and death in patients with immune-mediated inflammatory diseases receiving cytokine inhibitors compared with patients with immune-mediated inflammatory disease not receiving cytokine inhibitors Significant results (p<0·05) are reported in red, non-significant results are reported in grey. Only studies that reported relative risk values for biological and targeted synthetic DMARD exposure were included in the figure., , , , , , , , DMARD=disease modifying anti-rheumatic drug. ICU=intensive care unit. *DMARDs. †JAK inhibitors. ‡Rituximab. §TNF inhibitors. ¶IL-17 inhibitors.
See this image and copyright information in PMC

References

    1. Wu F, Zhao S, Yu B, et al. A new coronavirus associated with human respiratory disease in China. Nature. 2020;579:265–269. - PMC - PubMed
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. - PMC - PubMed
    1. Najm A, Alunno A, Mariette X, et al. Pathophysiology of acute respiratory syndrome coronavirus 2 infection: a systematic literature review to inform EULAR points to consider. RMD Open. 2021;7 - PMC - PubMed
    1. Schett G, Sticherling M, Neurath MF. COVID-19: risk for cytokine targeting in chronic inflammatory diseases? Nat Rev Immunol. 2020;20:271–272. - PMC - PubMed
    1. Meroni PL, Zavaglia D, Girmenia C. Vaccinations in adults with rheumatoid arthritis in an era of new disease-modifying anti-rheumatic drugs. Clin Exp Rheumatol. 2018;36:317–328. - PubMed

LinkOut - more resources