AB0706 ASSOCIATED RISK FACTORS AND OUTCOMES IN HOSPITALISED COVID-19 PATIENTS WITH BIOLOGICS AND JAK-INHIBITORS: A REPORT FROM A CENTER SPECIALISED IN IMMUNE-MEDIATED DISEASES

Abstract

Background:There’s little data of patients with immune diseases (ID) treated with biologic and JAK-inhibitors and COVID19. Current consensus is to keep treatment, however more studies are needed to ascertain the risk in these patients.Objectives:To describe the associated risk factors and outcomes in hospitalized patients with ID treated with biologics and JAK-inhibitors of a tertiary center.Methods:Observational retrospective study of patients with COVID19 from March 1st 2020 to January 31st 2021. Out of all the patients receiving subcutaneous (SC) or intravenous (IV) biologics and oral (PO) JAK-inhibitors, we selected those requiring hospitalization due to pneumonia for analysis. We collected demographic data, comorbidities, seasonal flu vaccination, smoking history and the outcome (discharge/admission in an intensive care unit (ICU)/death). We used a composite index (Charlston’s index) for comorbidities.Results:Of 153 patients, 29 (18.9%) were hospitalized. 18 (62%) were women with a median age of 61 (IQ 52-69). 14 (48.2%) had rheumatoid arthritis, 5 (17%) had axial spondylarthritis and 4 (13.7%) had Chron’s disease. The main IV was Rituximab in 3 (50%), and abatacept, infliximab and vedolizumab had one each. Of the SC, tocilizumab and adalimumab had 5 (22.7%) each, etanecept and golimumab had 3 (13.6%) each and secukinumab, ustekinumab and abatacept had 2 (9%) each. The PO was tofacitinib. There were no outcome differences for each treatment.24 (82.7%) patients had at least 1 comorbidity with significative difference between patients (Table 1). There were 6 (20.6%) deaths, 3 (50%) in the ICU, 2 (33%) did not meet the ICU criteria, and 1 (16%) before ICU admission. None them had the same ID.Table 1.Baseline data.Variables, (%)Total29 (100)Deaths 6 (20.6)Discharged23 (79.3)PWomen (%)18 (62)4 (66.6)14 (61)0.79Age, Median (IQ range)61 (52-69)69.5 (62-78.5)59.9 (51-65.5)0.09Flu vaccine (%)15 (51.7)5 (83.3)10 (43.7)0.08ICU (%)8 (27.5)3 (50)5 (22)0.16TreatmentIV (%)6 (20.1)4 (66.7)2 (8.7)0.001SC (%)22 (75.8)2 (33.3)20 (87)<0.0001PO (%)1 (3.4)0 (0)1 (4.3)0.6ComorbiditiesCharlston, Mean (standard deviation)2.72 (+/-1.6)5.16 (+/- 1.8)2.08 (+/-1.5)<0.0001Hypertension/HTA (%)16 (55)5 (83.3)11 (48)0.11Dyslipidemia/DL (%)12 (41.3)4 (66.7)8 (34.8)0.15Obesity (%)10 (34.5)1 (16.7)9 (39.1)0.30Chronic obstructive pulmonary disease/COPD (%)3 (10.3)3(50)0 (0)<0.0001Heart disease (%)8 (27.5)4 (66.6)4 (17.4)0.01Chronic kidney disease/CKD (%)7 (24.1)4 (66.6)3 (13)0.006Diabetes mellitus /DM (%)7 (24.1)3 (50)4 (17.4)0.001Previous or current smokers (%)9 (31)3 (50)6 (26)0.26Conclusion:The rate of COVID19 hospitalization in our patients was comparable to the general population’s (between 19-24% from 60 years plus) and the risk of in-patient death is also similar, around 24%1. Our study suggests that neither their ID nor their treatment influences their risk of a worse outcome.COPD, DM and previous heart disease were associated with worse outcome; however it seems that the main prognostic factor was the overall impact of comorbidities associated; as measured by the Charlston’s index, being significantly higher in the patients with a fatal outcome.A fatal outcome was more likely in IV biologics, however it could be explained by indication bias probably due to higher comorbidity and disability in these patients rather than an independent prognostic variable.