Great article: https://www.medpagetoday.com/rheumatology/generalrheumatology/91022?vpass=1
This is aproffesional Membership site by the text of the article in part says; (Note the comment about our old friend Predi) and as they said “A limitation of the study was its retrospective design.”
"Another study has provided reassuring data on COVID-19 outcomes among patients with underlying autoimmune and chronic inflammatory diseases, though highlighting the potential risks of corticosteroid use.
In a multicenter retrospective study, no increased risk for mechanical ventilation or death associated with COVID-19 was seen for patients with autoimmune or chronic inflammatory diseases (OR 1.3, 95% CI 0.9-1.8, P =0.235), according to Ryan C. Ungaro, MD, and colleagues from the Icahn School of Medicine at Mount Sinai in New York City.
However, treatment with systemic corticosteroids raised the risk significantly, with an odds ratio of 6.8 (95% CI 2.5-18.4, P <0.001), the researchers reported online in ACR Open Rheumatology .
Similar results were observed in a report from last summer of outcomes among patients with inflammatory bowel diseases, also by Ungaro and colleagues, in which the standardized mortality ratio for patients with inflammatory bowel disease in the U.S. was 1.7 (95% CI 0.9-2.5), but the adjusted odds ratio for severe disease or mortality among patients on systemic corticosteroids was 6.9 (95% CI 2.3-20.5).
Concerns have been raised about elevated risks for severe COVID-19 among patients with underlying conditions that affect the immune system and who typically are treated with immunomodulating medications. “Autoimmune and chronic inflammatory diseases, prevalent in 5% to 7% of developed countries, are associated with an increased risk of infection related to immunosuppression and disease activity,” Ungaro’s group wrote.
But data are only beginning to emerge on COVID outcomes among patients with these underlying diseases, and how treatments might influence disease severity and complications.
To address these concerns, the researchers analyzed electronic health record data from five hospitals in the Mount Sinai Health System in New York for patients who tested positive for COVID-19 from March 1 to May 12, 2020.
Underlying diagnoses of interest included rheumatoid arthritis, inflammatory bowel disease, scleroderma, psoriasis/psoriatic arthritis, systemic lupus erythematosus, ankylosing spondylitis, vasculitis, Behcet’s disease, and autoimmune hepatitis or pancreatitis.
The analysis adjusted for risk factors including age over 70, sex, race, diabetes, cardiovascular disease, obesity, chronic kidney disease, and chronic obstructive pulmonary disease (COPD).
During the study period, 6,792 patients were identified as having PCR-confirmed COVID-19, with 2.3% (159) having an underlying autoimmune or inflammatory disease. The most common diseases were rheumatoid arthritis, inflammatory bowel disease, and systemic lupus erythematosus.
Patients with underlying diseases were more likely to be female, white, to be obese, to have a history of asthma, and to have been diagnosed with a malignancy.
They also were more likely to be admitted to the hospital (84.3% vs 68.1%, P <0.001), but did not have higher rates of mechanical ventilation (28.3% vs 25.8%, P =0.534) or mortality (22.6% vs 21.8%, P =0.872).
On the multivariate analysis, underlying autoimmune or inflammatory disease showed no association with severe COVID-19 (mechanical ventilation or mortality), but several other factors did show significant associations ( P <0.001 for all):
** Age over 70, OR 3.1 (95% CI 2.7-3.5)*
** Male sex, OR 1.3 (95% CI 1.2-1.5)*
** Cardiovascular disease, OR 1.7 (95% CI 1.5-2.0)*
** Diabetes, OR 1.6 (95% CI 1.4-1.8)*
** Chronic kidney disease, OR 2.0 (95% CI 1.7-2.4)*
** COPD, OR 1.4 (95% CI 1.2-1.9)*
** Obesity, OR 1.4 (95% CI 1.2-1.6)*
With regard to the influence of treatments, while steroids were associated with a nearly sevenfold increased risk of severe COVID-19, there was no association for biologics (OR 1.0, 95% CI 0.3-3.5, P =0.977) or nonbiologic immunosuppressives (OR 0.7, 95% CI 0.3-1.8, P =0.434).
The finding that biologics and immunosuppressive drugs did not appear to increase the risk of severe COVID-19 was “an important observation,” according to the researchers.
"Overall, our data suggest that patients with autoimmune and chronic inflammatory diseases should stay on their medications during this pandemic with the exception of corticosteroids, which should ideally be tapered to the lowest possible dose weighing the risks and benefits of these therapies in the individual patient," they stated.
A limitation of the study was its retrospective design."
The authors reported support from the National Institutes of Health and the Crohn’s and Colitis Foundation.
They also reported financial relationships with Eli Lilly, Janssen, Pfizer, Takeda, AbbVie, Boehringer Ingelheim, Amgen, Allergan, Ferring Pharmaceuticals, Shire, Arena, Celgene, Celltrion, Enterome, Genentech, Landos, Ipsen, MedImmune, Merck, Novartis, TiGenix, Viela Bio, Intestinal Biotech Development, and Genfit.
ACR Open Rheumatology