Effect of Immunosuppressive or Immunomodulatory Agents on Severe COVID‐19 Outcomes: A Population‐Based Cohort Study
Objective We estimated the association between immunosuppressive and immunomodulatory agent (IIA) exposure and severe COVID‐19 outcomes in a population‐based cohort study. Methods Participants were 18 years or older, tested positive for SARS‐CoV‐2 between February 6, 2020, and August 15, 2021, and w...
Saved in:
Published in | ACR open rheumatology Vol. 5; no. 12; pp. 685 - 693 |
---|---|
Main Authors | , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Boston, USA
Wiley Periodicals, Inc
01.12.2023
John Wiley & Sons, Inc Wiley |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Objective
We estimated the association between immunosuppressive and immunomodulatory agent (IIA) exposure and severe COVID‐19 outcomes in a population‐based cohort study.
Methods
Participants were 18 years or older, tested positive for SARS‐CoV‐2 between February 6, 2020, and August 15, 2021, and were from administrative health data for the entire province of British Columbia, Canada. IIA use within 3 months prior to positive SARS‐CoV‐2 test included conventional disease‐modifying antirheumatic drugs (antimalarials, methotrexate, leflunomide, sulfasalazine, individually), immunosuppressants (azathioprine, mycophenolate mofetil/mycophenolate sodium [MMF], cyclophosphamide, cyclosporine, individually and collectively), tumor necrosis factor inhibitor (TNFi) biologics (adalimumab, certolizumab, etanercept, golimumab, infliximab, collectively), non‐TNFi biologics or targeted synthetic disease‐modifying antirheumatic drugs (tsDMARDs) (rituximab separately from abatacept, anakinra, secukinumab, tocilizumab, tofacitinib and ustekinumab collectively), and glucocorticoids. Severe COVID‐19 outcomes were hospitalizations for COVID‐19, ICU admissions, and deaths within 60 days of a positive test. Exposure score–overlap weighting was used to balance baseline characteristics of participants with IIA use compared with nonuse of that IIA. Logistic regression measured the association between IIA use and severe COVID‐19 outcomes.
Results
From 147,301 participants, we identified 515 antimalarial, 573 methotrexate, 72 leflunomide, 180 sulfasalazine, 468 immunosuppressant, 378 TNFi biologic, 49 rituximab, 144 other non‐TNFi biologic or tsDMARD, and 1348 glucocorticoid prescriptions. Risk of hospitalizations for COVID‐19 was significantly greater for MMF (odds ratio [95% CI]): 2.82 [1.81‐4.40], all immunosuppressants: 2.08 [1.51‐2.87], and glucocorticoids: 1.63 [1.36‐1.96], relative to nonuse. Similar outcomes were seen for ICU admission and MMF: 2.52 [1.34‐4.74], immunosuppressants: 2.88 [1.73‐4.78], and glucocorticoids: 1.86 [1.37‐2.54]. Only glucocorticoids use was associated with a significant increase in 60‐day mortality: 1.58 [1.21‐2.06]. No other IIAs displayed statistically significant associations with severe COVID‐19 outcomes.
Conclusion
Current use of MMF and glucocorticoids were associated with an increased risk of severe COVID‐19 outcomes compared with nonuse. These results emphasize the variety of circumstances of patients taking IIAs. |
---|---|
Bibliography: | Bonnie Corradetti, BN Med: Arthritis Research Canada, Vancouver, British Columbia, and Kidney Section of the Medicine Strategic Clinical Network, Alberta Health, Edmonton, Canada This work was supported by the Michael Smith Foundation for Health Research (grant COV‐2020‐1075) and the British Columbia Support for People & Patient‐Oriented Research & Trials Unit (grant C19‐PE‐V3). Dr. Loree receives research support through a Michael Smith Health Professional Investigator Award. Dr. Lacaille's work was supported by the Mary Pack Chair in Rheumatology Research by the University of British Columbia and the Arthritis Society of Canada. Dr. Aviña‐Zubieta's work was supported by the British Columbia Lupus Society Scholar Award and he is the Walter & Marilyn Booth Research Scholar. https://onlinelibrary.wiley.com/doi/10.1002/acr2.11620 . 1 2 Jeremiah Tan, BSc, Diane Lacaille, MD, MHSc, Jacek A. Kopec, MD, PhD, John M. Esdaile, MD, MPH, Alison M. Hoens, MSc, J. Antonio Aviña‐Zubieta, MD: Arthritis Research Canada and University of British Columbia, Vancouver, Canada 3 4 5 Shelby Marozoff, MSc, Na Lu, MPH, Ayesha Kirmani, MBBS, Peter Malone, Philippa Mennell: Arthritis Research Canada, Vancouver, British Columbia, Canada 6 Cheryl L. Koehn: Arthritis Research Canada and Arthritis Consumer Experts, Vancouver, British Columbia, Canada. Author disclosures are available at Jonathan M. Loree, MD, MS: BC Cancer and University of British Columbia, Vancouver, Canada Hui Xie, PhD: Arthritis Research Canada, Vancouver, and Simon Fraser University, Burnaby, British Columbia, Canada ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Author disclosures are available at https://onlinelibrary.wiley.com/doi/10.1002/acr2.11620. 1Shelby Marozoff, MSc, Na Lu, MPH, Ayesha Kirmani, MBBS, Peter Malone, Philippa Mennell: Arthritis Research Canada, Vancouver, British Columbia, Canada; 2Jeremiah Tan, BSc, Diane Lacaille, MD, MHSc, Jacek A. Kopec, MD, PhD, John M. Esdaile, MD, MPH, Alison M. Hoens, MSc, J. Antonio Aviña‐Zubieta, MD: Arthritis Research Canada and University of British Columbia, Vancouver, Canada; 3Jonathan M. Loree, MD, MS: BC Cancer and University of British Columbia, Vancouver, Canada; 4Hui Xie, PhD: Arthritis Research Canada, Vancouver, and Simon Fraser University, Burnaby, British Columbia, Canada; 5Bonnie Corradetti, BN Med: Arthritis Research Canada, Vancouver, British Columbia, and Kidney Section of the Medicine Strategic Clinical Network, Alberta Health, Edmonton, Canada; 6Cheryl L. Koehn: Arthritis Research Canada and Arthritis Consumer Experts, Vancouver, British Columbia, Canada. |
ISSN: | 2578-5745 2578-5745 |
DOI: | 10.1002/acr2.11620 |