S855 Characteristics, Comorbidities, and Outcomes of SARS-CoV-2 Infection in Patients With Conditions Treated With Systemic Immunosuppressive Therapies: A Population-Based Study

Abstract

Introduction: We describe the characteristics and COVID-19 clinical outcomes in this pt population, compared with the general population. Methods: This descriptive retrospective cohort study used data from the US Optum® deidentified COVID-19 electronic health record dataset (2007–2020). Adults with COVID-19 were stratified into 3 disease cohorts (pts with rheumatoid arthritis [RA], psoriatic arthritis [PsA], or UC who had received systemic immunosuppressive therapy) and a comparator cohort that did not meet these criteria. Incidence proportions of hospitalization, intensive care unit admission, in-hospital death, all-cause mortality, and clinical manifestations of interest were calculated. Logistic regression was used in exploratory analyses to estimate the risk of endpoints, adjusting for demographics (age, sex, race, region), and demographics plus comorbidities. Results: This analysis (Feb 01–Dec 09, 2020) included 315,101 COVID-19 pts. The incidence of hospitalization due to COVID-19 was greatest in the RA cohort compared with the PsA, UC, and comparator cohorts (Table). Adjusting for demographics, and demographics plus comorbidities, COVID-19 pts with RA had an increased risk of hospitalization and in-hospital death, compared with the comparator cohort (Figure). Adjusting for demographics, pts with UC had an increased risk of hospitalization; after adjustment for demographics plus comorbidities, the risk was no longer statistically significant (Figure). There was no statistically significant increased risk of hospitalization among pts with PsA (Figure). The risk of hospitalization was lower in COVID-19 pts with RA receiving tumor necrosis factor inhibitors (TNFi) vs non-TNFi biologics (0.32 [0.20, 0.53]) and vs the comparator cohort (0.77 [0.51, 1.17]). Compared with the comparator cohort, the risk of hospitalization due to COVID-19 was similar between pts with RA receiving tofacitinib (1.06 [0.55, 2.05]), JAK inhibitors (1.26 [0.74, 2.16]) or csDMARDs (1.21 [1.02, 1.44]). The risk of hospitalization due to COVID-19 was greater in pts with RA receiving non-TNFi biologics vs the comparator cohort (2.33 [1.79, 3.04]). A similar analysis was not performed for the UC and PsA cohorts due to small sample sizes. Conclusion: Compared with the comparator cohort, pts with RA were at a higher risk of more severe COVID-19, and except for non-TNFi biologics, immunosuppressive therapies in general did not further increase the risk. COVID-19 outcomes in pts with UC were generally similar to the comparator cohort.Figure 1.: Adjusted odds ratios of each endpoint in the (A) RA cohort, (B) UC cohort, and (C) PsA cohort vs the comparator cohort. a.Covariates included in logistic regression models were age, sex, race, and region; b.Covariates included in logistic regression models were age, sex, race, region, lung disease (interstitial lung disease, asthma, and chronic obstructive pulmonary disease), VTE, hypertension, coronary artery disease, serious infections (hospitalized), cancer, diabetes, CKD or dialysis, and liver disease, except for UC, which did not include serious infections (hospitalized). Odds ratios using this model are only displayed for endpoints for which there were ≥ 30 events; c.Serious infections (hospitalized) was not included as a covariate; d.CKD/dialysis was not included as a covariate; e. VTE was not included as a covariate. ARDS, acute respiratory distress syndrome; CI, confidence interval; CKD, chronic kidney disease; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; PsA, psoriatic arthritis; RA, rheumatoid arthritis; UC, ulcerative colitis.Table 1.: Baseline Characteristics and IPs of Clinical Manifestations/Outcomes in the RA, PsA, UC, and Comparator Cohorts. a.At least 1 diagnosis of RA, PsA, or UC, and treatment with IM therapy (JAK inhibitor, TNFi, non-TNFi biologic, or csDMARD) within 2 yrs prior to SARS-CoV-2 diagnosis date; b.Absence of a diagnosis of RA, PsA, or UC, and no treatment with IM therapy within 2 yrs prior to SARS-CoV-2 diagnosis date; c.Baseline was defined as within 6 months prior to SARS-CoV-2 diagnosis date; d.csDMARDs included auranofin, aurothioglucose, azathioprine, chloroquine hydrochloride, chloroquine phosphate, cyclophosphamide, cyclosporine, gold sodium thiomalate, hydroxychloroquine sulfate, leflunomide, mercaptopurine, mesalamine, methotrexate, minocycline hydrochloride, n-acetylpenicillamine, penicillamine, primaquine, sulfasalazine, tacrolimus, and thalidomide; e.Within 90 days prior to SARS-CoV-2 diagnosis date; f.Denominator is the number of pts hospitalized within 30 days of SARS-CoV-2 diagnosis; defined as death during hospitalization; g.Within 90 days of SARS-CoV-2 diagnosis date; h.Within 30 days of SARS-CoV-2 diagnosis date. ARDS, acute respiratory distress syndrome; CI, confidence interval; csDMARD, conventional synthetic disease-modifying antirheumatic drug; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; IM, immunomodulatory; IP, incidence proportion; IV, intravenous; JAK, Janus kinase; N, number of pts in the cohort; n, number of pts in the specified category; PsA, psoriatic arthritis; pts, patients; RA, rheumatoid arthritis; TNFi, tumor necrosis factor inhibitor; UC, ulcerative colitis.