Adults with pre-existing autoimmune disease (AID), exposure to immunosuppressants (IS), or both are more likely to have a life-threatening disease or hospitalization with COVID-19, researchers reported in Clinical Infectious Diseases.
Investigators sought to definitively determine whether adults with AID or those treated with IS experienced worse severity outcomes from COVID-19, using data from National COVID Cohort Collaborative (N3C) database. Primary outcomes were the presence of life-threatening disease and hospitalization. The investigators used logistic regression models with and without adjustment for demographics and comorbidities to evaluate outcomes.
This retrospective cohort study included data from adults with a laboratory-confirmed positive COVID-19 diagnosis from a positive SARS-CoV-2 polymerase chain reaction (PCR) or antigen test from January 1, 2020, to June 30, 2022. The cohort included 2,453,799 patients (mean [SD] age, 47.4 [18.0] years; 59% female); of those, 220,353 (9%) were hospitalized and 54,932 (2.2%) had life-threatening disease. The cohort was further categorized according to patients with a pre-existing AID (n=191,520), those with IS exposure (n=278,095), or those with both (n= 56,813). A majority of patients with COVID-19 had 1 pre-existing AID diagnosis (n=159,770) and exposure to a single IS (n=237,238, which was 85.31% of patients with IS exposure).
The final analysis model adjusted for demographics and pre-existing comorbidities showed that patients were about 21% more likely to be hospitalized if they had pre-existing AID (odds ratio [OR] 1.21; 95% CI, 1.19-1.24; P <.001), 19% more likely if they had previous IS exposure (OR 1.19; 95% CI, 1.17-1.21; P <.001), or 31% more likely if they had both (OR 1.31; 95% CI, 1.28-1.34, P <.001).
Our results confirmed that effects of AID, IS, or both on COVID-19 severity outcomes were significant across the different race and gender groups.
Patients were 13% more likely to have life-threatening COVID-19 if they had a pre-existing AID (OR 1.13; 95% CI, 1.10-1.17, P <.001), 27% more likely if they had prior IS exposure (OR 1.27; 95% CI, 1.24-1.30, P <.001), or 35% more likely if they had both (OR 1.35; 95% CI, 1.29-1.40, P <.001), after adjustment for demographics and comorbidities.
Use of antivirals was protective (life-threatening disease: OR 0.31; 95% CI, 0.21-0.45; P <.001; and hospitalization: OR 0.30; 95% CI, 0.25-0.36; P <.001), after adjustment. Exposure to tumor necrosis factor inhibitors was protective against severe COVID-19 outcomes (OR of life-threatening disease: 0.80; 95% CI, 0.66-0.96; P =.017; and hospitalization: OR 0.80; 95% CI, 0.73-0.89; P <.001), after adjustment.
Limitations include the retrospective design, limited data on patient medical history, and lack of complete patient vaccination data.
“Our results confirmed that effects of AID, IS, or both on COVID-19 severity outcomes were significant across the different race and gender groups,” noted the investigators. Moreover, this study is likely “the largest, most comprehensive systematic analysis of the effects of AID, IS, or both on COVID-19 severity outcomes,” and as such “provides a more definitive answer to previous discrepant findings on whether patients with AID and/or IS are at higher risk for worse COVID-19 related outcomes,” said the investigators.
Disclosure: One study author declared an affiliation with a pharmaceutical company. Please see the original reference for a full list of disclosures.