Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis.

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  • Additional Information
    • Source:
      Publisher: BioMed Central Country of Publication: England NLM ID: 101154438 Publication Model: Electronic Cited Medium: Internet ISSN: 1478-6362 (Electronic) Linking ISSN: 14786354 NLM ISO Abbreviation: Arthritis Res Ther Subsets: MEDLINE
    • Publication Information:
      Original Publication: London : BioMed Central, 2003-
    • Subject Terms:
      COVID-19 Drug Treatment*; Adrenal Cortex Hormones/*administration & dosage ; Antirheumatic Agents/*administration & dosage ; Arthritis/*drug therapy ; Immunosuppressive Agents/*administration & dosage; Adrenal Cortex Hormones/adverse effects ; Adult ; Aged ; Arthritis/diagnosis ; Arthritis/epidemiology ; COVID-19/diagnosis ; COVID-19/epidemiology ; Cohort Studies ; Cross-Sectional Studies ; Female ; Follow-Up Studies ; Humans ; Italy/epidemiology ; Male ; Middle Aged
    • Abstract:
      Background: Prevalence and outcomes of coronavirus disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis.
      Methods: The study was conducted in the arthritis outpatient clinic at two large academic hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of severe acute respiratory syndrome-coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25 February to 20 April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 development was evaluated.
      Results: The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04-1.44] to 3.20 [1.97-5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18-1.21] to 0.47 [0.46-0.48]). No independent effects of csDMARDs, age, sex, and comorbidities were observed.
      Conclusions: During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection.
      Trial Registration: Retrospectively registered. Not applicable.
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    • Contributed Indexing:
      Keywords: Biologic drugs; COVID-19; Glucocorticoids; Rheumatic diseases; SARS-CoV-2
    • Accession Number:
      0 (Adrenal Cortex Hormones)
      0 (Antirheumatic Agents)
      0 (Immunosuppressive Agents)
    • Publication Date:
      Date Created: 20201231 Date Completed: 20210114 Latest Revision: 20240805
    • Publication Date:
      20240805
    • Accession Number:
      PMC7772957
    • Accession Number:
      10.1186/s13075-020-02395-6
    • Accession Number:
      33380344