J Am Acad Dermatol . Antecedent Immunosuppressive Therapy for Immune-Mediated Inflammatory Diseases in the Setting of a COVID-19 Outbreak

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J Am Acad Dermatol


. 2020 Jul 28;S0190-9622(20)32290-8.
doi: 10.1016/j.jaad.2020.07.089. Online ahead of print.
Antecedent Immunosuppressive Therapy for Immune-Mediated Inflammatory Diseases in the Setting of a COVID-19 Outbreak


Jesse Veenstra ¹ , Connor R Buechler ² , Gabrielle Robinson ³ , Stephanie Chapman ³ , Madeline Adelman ² , Aaron Tisack ² , Peter Dimitrion ² , Erika Todter ⁴ , Laurie Kohen ³ , Henry W Lim ³



Affiliations

• PMID: 32735965
• DOI: 10.1016/j.jaad.2020.07.089

Abstract

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 retrospective cohort analysis of Henry Ford Health System (HFHS) patients tested for COVID-19 between February 1^st and April 18^th, 2020 treated with IS medication for IMID. Therapeutic class of IS medication, comorbidities, and demographic factors were combined into multivariate models to determine predictors of COVID-19 infection, admission, ventilation, and mortality.
Results: Of 213 IMID patients, 36.2% tested positive for COVID-19, who had no greater odds of being hospitalized or requiring ventilation relative to the general population. No IS therapeutic worsened the course of disease after multivariate correction, though multi-drug regimens and biologics predicted an increased and decreased rate of hospitalization, respectively, with the latter driven by TNFα inhibitors.
Limitations: A single-center study somewhat limits generalization to community-based settings. Only patients tested for COVID-19 were analyzed.
Conclusion: IS therapies for IMIDs are not associated with a significantly greater risk of SARS-CoV-2 or severe sequelae when controlling for other factors, and TNFα inhibitors may decrease odds of severe infection.

Keywords: Autoimmune disease; Biologics; COVID-19; Coronavirus; DMARDs; Immune-Mediated Inflammatory Diseases; Immunosuppression; SARS-CoV-2.