Fitzgerald Kathryn C, Mecoli Christopher A, Douglas Morgan, Harris Samantha, Aravidis Berna, Albayda Jemima, Sotirchos Elias S, Hoke Ahmet, Orbai Ana-Maria, Petri Michelle, Christopher-Stine Lisa, Baer Alan N, Paik Julie J, Adler Brittany L, Tiniakou Eleni, Timlin Homa, Bhargava Pavan, Newsome Scott D, Venkatesan Arun, Chaudhry Vinay, Lloyd Thomas E, Pardo Carlos A, Stern Barney J, Lazarev Mark, Truta Brindusa, Saidha Shiv, Chen Edward S, Sharp Michelle, Gilotra Nisha, Kasper Edward K, Gelber Allan C, Bingham Clifton O, Shah Ami A, Mowry Ellen M
Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
medRxiv. 2021 Feb 5:2021.02.03.21251069. doi: 10.1101/2021.02.03.21251069.
People with autoimmune or inflammatory conditions who take immunomodulatory/suppressive medications may have a higher risk of novel coronavirus disease 2019 (COVID-19). Chronic disease care has also changed for many patients, with uncertain downstream consequences.
Assess whether COVID-19 risk is higher among those on immunomodulating or suppressive agents and characterize pandemic-associated changes to care.
Longitudinal registry study.
4666 individuals with autoimmune or inflammatory conditions followed by specialists in neurology, rheumatology, cardiology, pulmonology or gastroenterology at Johns Hopkins.
Periodic surveys querying comorbidities, disease-modifying medications, exposures, COVID-19 testing and outcomes, social behaviors, and disruptions to healthcare.
A total of 265 (5.6%) developed COVID-19 over 9 months of follow-up (April-December 2020). Patient characteristics (age, race, comorbidity, medication exposure) were associated with differences in social distancing behaviors during the pandemic. Glucocorticoid exposure was associated with higher odds of COVID-19 in multivariable models incorporating behavior and other potential confounders (OR: 1.43; 95%CI: 1.08, 1.89). Other medication classes were not associated with COVID-19 risk. Diabetes (OR: 1.72; 95%CI: 1.08, 2.73), cardiovascular disease (OR: 1.68; 95%CI: 1.24, 2.28), and chronic kidney disease (OR: 1.76; 95%CI: 1.04, 2.97) were each associated with higher odds of COVID-19. Pandemic-related disruption to care was common. Of the 2156 reporting pre-pandemic utilization of infusion, mental health or rehabilitative services, 975 (45.2%) reported disruptions. Individuals experiencing changes to employment or income were at highest odds of care disruption.
Results may not be generalizable to all patients with autoimmune or inflammatory conditions. Information was self-reported.
Exposure to glucocorticoids may increase risk of COVID-19 in people with autoimmune or inflammatory conditions. Disruption to healthcare and related services was common. Those with pandemic-related reduced income may be most vulnerable to care disruptions.
患有自身免疫性或炎症性疾病且服用免疫调节/抑制药物的人群感染2019年新型冠状病毒病（COVID-19）的风险可能更高。许多患者的慢性病护理也发生了变化，其下游后果尚不确定。
评估服用免疫调节或抑制药物的人群感染COVID-19的风险是否更高，并描述与大流行相关的护理变化。
纵向登记研究。
约翰·霍普金斯大学的神经科、风湿科、心内科、肺科或胃肠病科专家随访的4666例患有自身免疫性或炎症性疾病的患者。
定期调查询问合并症、改善病情的药物、暴露情况、COVID-19检测及结果、社会行为以及医疗保健的中断情况。
在9个月的随访期（2020年4月至12月）内，共有265例（5.6%）患者感染了COVID-19。患者特征（年龄、种族、合并症、药物暴露）与大流行期间社交距离行为的差异有关。在纳入行为和其他潜在混杂因素的多变量模型中，糖皮质激素暴露与感染COVID-19的较高几率相关（比值比：1.43；95%置信区间：1.08，1.89）。其他药物类别与COVID-19风险无关。糖尿病（比值比：1.72；95%置信区间：1.08，2.73）、心血管疾病（比值比：1.68；95%置信区间：1.24，2.28）和慢性肾脏病（比值比：1.76；95%置信区间：1.04，2.97）均与感染COVID-19的较高几率相关。与大流行相关的护理中断很常见。在2156例报告大流行前使用输液、心理健康或康复服务的患者中，975例（45.2%）报告有中断情况。经历就业或收入变化的个体护理中断几率最高。
结果可能不适用于所有患有自身免疫性或炎症性疾病的患者。信息为自我报告。
糖皮质激素暴露可能会增加患有自身免疫性或炎症性疾病的人群感染COVID-19的风险。医疗保健及相关服务的中断很常见。与大流行相关收入减少的人群可能最易受到护理中断的影响。
