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Brief Report

Direct and Indirect Impact of COVID-19 for Patients with Immune-Mediated Inflammatory Diseases: A Retrospective Cohort Study

1
Department of Epidemiology, Lazio Regional Health Service, 00147 Rome, Italy
2
IBD Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica, 00168 Roma, Italy
3
National Institute for Infectious Diseases, Lazzaro Spallanzani, IRCCS, 00149 Roma, Italy
4
Department of Clinical and Molecular Medicine, Sant’Andrea University Hospital, Sapienza University of Rome, 00189 Rome, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Antonio Muro
J. Clin. Med. 2021, 10(11), 2388; https://doi.org/10.3390/jcm10112388
Received: 29 April 2021 / Revised: 24 May 2021 / Accepted: 26 May 2021 / Published: 28 May 2021
(This article belongs to the Special Issue Clinical Trends and Therapies of the COVID-19 Pandemic)
Importance: Since the beginning of the Coronavirus Disease-19 (COVID-19) pandemic, Severe Acute Respiratory Syndrome-CoV-2 (SARS-CoV-2) infection has been a serious challenge for immune-compromised patients with immune-mediated inflammatory diseases (IMIDs). Objective: Our aim was to investigate the impact of COVID-19 in terms of risks of infection, hospitalization and mortality in a cohort of patients with rheumatoid arthritis (RA), psoriasis (PSO) or inflammatory bowel disease (IBD). Furthermore, we studied the impact of SARS-CoV-2 infection on the prescribed drug regimen in these patients. Methods: Through the record linkage between health information systems, a cohort of patients, ≥18 years old, assisted in the Lazio region and who had suffered from immune-mediated inflammatory diseases (RA, PSO, IBD) between 2007 and 2019, was identified. The risk of infection, hospitalization or mortality for COVID-19, was assessed by logistic regression models, and reported in an Odds Ratio (ORs; CI 95%), adjusting for sex, age and the Charlson Comorbidity Index. We also estimated these risks separately by IMID and in the subgroup of prevalent biologic drug users. We investigated deferral of biological treatments in the study population by comparing the prevalence of weekly use of biologicals (2019–2020) before and during the pandemic periods. Findings: Within the 65,230 patients with IMIDs, the cumulative incidence for COVID-19 was 303/10,000 ab. In this cohort of patients, we observed a significantly higher risk of SARS-CoV-2 infection than the general population: OR = 1.17 (95% CI 1.12–1.22). The risk was higher even considering separately each disease and in the subgroup of prevalent biologic drug users. This last subgroup of patients showed a higher risk of death related to COVID-19 (OR 1.89; 95% CI 1.04–3.33) than the general population. However, no differences in terms of risks of hospitalization or death related to COVID-19 were recorded in patients with the IMIDs. Comparing the 2019–2020 prevalence of weekly biological drug treatments in prevalent biologic drug users, we found a decrease (−19.6%) during the lockdown, probably due to pandemic restrictions. Conclusions and Relevance: Patients with IMIDs seem to have a higher risk of SARS-CoV2 infection. However, other than for patients with prevalent biologic drug treatment, no significant differences in terms of hospitalization and mortality were reported compared to the general populations; further investigation is warranted on account of unmeasured confounding. In addition, during the lockdown period, the COVID-19 emergency highlighted a lower use of biologic drugs; this phenomenon requires strict pharmacological monitoring as it could be a proxy of forthcoming long-term clinical progression. View Full-Text
Keywords: COVID-19; immune-mediated inflammatory diseases; rheumatoid arthritis; inflammatory bowel diseases; psoriasis COVID-19; immune-mediated inflammatory diseases; rheumatoid arthritis; inflammatory bowel diseases; psoriasis
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MDPI and ACS Style

Belleudi, V.; Rosa, A.C.; Poggi, F.R.; Armuzzi, A.; Nicastri, E.; Goletti, D.; Diamanti, A.P.; Davoli, M.; Agabiti, N.; Addis, A. Direct and Indirect Impact of COVID-19 for Patients with Immune-Mediated Inflammatory Diseases: A Retrospective Cohort Study. J. Clin. Med. 2021, 10, 2388. https://doi.org/10.3390/jcm10112388

AMA Style

Belleudi V, Rosa AC, Poggi FR, Armuzzi A, Nicastri E, Goletti D, Diamanti AP, Davoli M, Agabiti N, Addis A. Direct and Indirect Impact of COVID-19 for Patients with Immune-Mediated Inflammatory Diseases: A Retrospective Cohort Study. Journal of Clinical Medicine. 2021; 10(11):2388. https://doi.org/10.3390/jcm10112388

Chicago/Turabian Style

Belleudi, Valeria, Alessandro C. Rosa, Francesca R. Poggi, Alessandro Armuzzi, Emanuele Nicastri, Delia Goletti, Andrea P. Diamanti, Marina Davoli, Nera Agabiti, and Antonio Addis. 2021. "Direct and Indirect Impact of COVID-19 for Patients with Immune-Mediated Inflammatory Diseases: A Retrospective Cohort Study" Journal of Clinical Medicine 10, no. 11: 2388. https://doi.org/10.3390/jcm10112388

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