COVID-19 risk and outcomes in adult asthmatic patients treated with biologics or systemic corticosteroids: Nationwide real-world evidence.
COVID-19 risk and outcomes in adult asthmatic patients treated with biologics or systemic corticosteroids: Nationwide real-world evidence.
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DOI：
10.1016/j.jaci.2021.06.006
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发表时间：
2021-08
期刊：
影响因子：
--
通讯作者：
Saliba W
中科院分区：
文献类型：
--
作者：
Adir Y;Humbert M;Saliba W
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行期间管理严重哮喘具有挑战性，特别是由于使用全身性皮质类固醇和生物制剂的安全性问题。我们试图确定哮喘患者中生物制剂或全身性皮质类固醇使用与SARS-CoV-2和2019冠状病毒病（COVID-19）结果的PCR阳性之间的关系。我们使用了以色列最大的医疗保健提供者Clalit Health Services的计算机化数据库，以确定2020年3月1日至2020年12月7日期间接受SARS-CoV-2 PCR检测的所有哮喘成年患者。使用队列方法评估生物制剂使用和类固醇治疗与COVID-19严重程度和90天死亡率之间的关联。总体而言，80，602名接受检测的哮喘患者中有8，242名SARS-CoV-2 PCR检测结果呈阳性。生物制剂和全身性皮质类固醇与SARS-CoV-2感染风险增加无关。多变量分析显示，生物制剂与中重度COVID-19风险显著增加无关，也与90天内中重度COVID-19或全因死亡率的复合终点无关。长期全身使用皮质类固醇与所有测试结果的风险显著增加相关。近期（过去120天内）全身性皮质类固醇使用（而非既往使用）与中度至重度COVID-19和中度至重度COVID-19或全因死亡的复合风险增加显著相关。批准用于哮喘和全身性皮质类固醇的生物制剂与SARS-CoV-2感染风险增加无关。相比之下，全身性皮质类固醇是COVID-19最严重程度和全因死亡率的独立风险因素。我们的研究结果强调了感染SARS-CoV-2的哮喘患者近期或当前暴露于全身皮质类固醇的风险。
Managing severe asthma during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging, particularly due to safety concerns regarding the use of systemic corticosteroids and biologics. We sought to determine the association between biologics or systemic corticosteroids use and PCR positivity for SARS-CoV-2 and coronavirus disease 2019 (COVID-19) outcomes among asthmatic patients. We used the computerized database of Clalit Health Services, the largest health care provider in Israel, to identify all asthmatic adult patients who underwent PCR testing for SARS-CoV-2, between March 1, 2020, and December 7, 2020. A cohort approach was used to assess the association between biologics use and steroids treatment and COVID-19 severity and 90-day mortality. Overall, 8,242 of 80,602 tested asthmatic patients had positive PCR testing result for SARS-CoV-2. Both biologics and systemic corticosteroids were not associated with increased risk of SARS-CoV-2 infection. Multivariate analyses revealed that biologics were not associated with a significantly increased risk of moderate to severe COVID-19, nor with the composite end point of moderate to severe COVID-19 or all-cause mortality within 90 days. Chronic systemic corticosteroid use was associated with significantly increased risk of all tested outcome. Recent (within the previous 120 days) systemic corticosteroid use, but not former use, was significantly associated with increased risk of both moderate to severe COVID-19 and the composite of moderate to severe COVID-19 or all-cause mortality. Biologics approved for asthma and systemic corticosteroids are not associated with increased risk of SARS-CoV-2 infection. In contrast, systemic corticosteroids are an independent risk factor for worst COVID-19 severity and all-cause mortality. Our findings underscore the risk of recent or current exposure to systemic corticosteroids in asthmatic patients infected with SARS-CoV-2.
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DOI：
10.1016/j.jaip.2020.11.020
发表时间：
2021-03
期刊：
The journal of allergy and clinical immunology. In practice
影响因子：
--
作者：
Green I;Merzon E;Vinker S;Golan-Cohen A;Magen E
通讯作者：
Magen E
DOI：
10.1016/s2213-2600(21)00013-8
发表时间：
2021-07
期刊：
The Lancet. Respiratory medicine
影响因子：
--
作者：
Bloom CI;Drake TM;Docherty AB;Lipworth BJ;Johnston SL;Nguyen-Van-Tam JS;Carson G;Dunning J;Harrison EM;Baillie JK;Semple MG;Cullinan P;Openshaw PJM;ISARIC investigators
通讯作者：
ISARIC investigators
DOI：
10.1183/13993003.03142-2020
发表时间：
2021-03
期刊：
The European respiratory journal
影响因子：
--
作者：
Izquierdo JL;Almonacid C;González Y;Del Rio-Bermudez C;Ancochea J;Cárdenas R;Lumbreras S;Soriano JB
通讯作者：
Soriano JB
影响因子：
16.2
作者：
Saliba, Walid;Barnett-Griness, Ofra;Auriel, Eitan
通讯作者：
Auriel, Eitan
影响因子：
9.6
作者：
Lieberman-Cribbin W;Rapp J;Alpert N;Tuminello S;Taioli E
通讯作者：
Taioli E