A Prospective Study into COVID-19 Like Symptoms in Patients with and Without Immune Mediated Inflammatory Diseases or Immunomodulating Drugs

Abstract

Backgrounds: Patients with an immune mediated inflammatory disorder or post solid organ transplantation (IMIDT), are at risk for infectious complications especially if they are treated with immunosuppressive drugs (imeds). There is still great uncertainty whether these IMIDT patients are more susceptible to COVID-19 than controls, and/or should be advised to avoid taking their immunosuppressive treatment.Methods: A Dutch prospective cohort study in patients with IMIDT and controls (healthy or no IMIDT) who were identified based on the hospital registration database. Participants prospectively registered COVID-like symptoms (CLS) over time, and filled in health questionnaires.Findings: Of the 8670 individuals approached, 2110 with IMIDT and 1067 controls agreed to participate. In March and April, 454 (22%) of IMIDT patients and 242 (23%) of controls recorded to have CLS, mostly mild, with a duration of (median, IQR) seven days (3-14) in the IMIDT group and six days (4-11) in the control group, with fever occurring in 178 (26%) of reported CLS episodes. Six (3%) of the IMIDT patients without imed and 11(5%) of the IMIDT patients with imed were hospitalized versus 2(1%) of the control group with CLS. In May and June, fewer episodes overall were recorded. Being female (OR 1·45 95%CI 1·15;1·82), wearing a face mask (OR 1·42 95%CI 1·13-1·77) and having a lung disease (OR 1·50 95%CI 1·20;1·88) were independently associated with a higher risk, but higher age (OR 0·96 95%CI 0·96;0·97) and having an IMIDT with immunosuppressive medication use (OR 0·68 95%CI 0·51;0·91) with a lower risk of experiencing CLS.Interpretation: Between March and July 2020, IMIDT patients, whether or not taking imeds, did not show an increased risk of reported COVID-like symptoms compared to controls. Continuing immunosuppressant drugs as long as not ill, while following the Dutch COVID rules, appears to be safe.Funding: This study was not funded.Declaration of Interests: All authors declare that they have no competing interests.Ethics Approval Statement: The study protocols of IENIMINI cohort study was approved by the Medical Ethics Committee Leiden Delft Den Haag (LDD).