Immunosuppressive Medications and COVID-19 Outcomes in Patients with Noninfectious Uveitis in the Era of COVID-19 Vaccinations.
Immunosuppressive Medications and COVID-19 Outcomes in Patients with Noninfectious Uveitis in the Era of COVID-19 Vaccinations.
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DOI：
10.1016/j.xops.2023.100411
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发表时间：
2024-03
影响因子：
--
通讯作者：
Acharya, Nisha R.
中科院分区：
文献类型：
--
作者：
Sechrist, Samantha J.;Tang, Emily;Sun, Yuwei;Arnold, Benjamin F.;Acharya, Nisha R.
关键词：
目的：确定接受免疫抑制治疗的非传染性葡萄膜炎(NIU)患者在新冠肺炎接种时代感染2019年冠状病毒(新冠肺炎)、住院和死亡的风险。2021年7月1日至2022年6月30日的回溯性队列研究，使用来自Optom Labs Data Warehouse(OLDW)已取消识别的索赔数据库的数据。从2017年1月1日起被诊断为NIU的患者，以及连续参加≥一年的OLDW患者。计算每个新冠肺炎结局的发生率(IR)。使用具有时间更新的门诊免疫抑制药物暴露的二分法指标的COX比例风险模型，估计每个变量和新冠肺炎结果的未调整和调整后的风险比(HR)。为了评估全身皮质类固醇(SC)暴露的剂量依赖效应，调整后的模型中包括了暴露期间泼尼松的平均日剂量。新冠肺炎感染、住院和死亡的风险比和内部收益率。本研究包括62例 和209例NIU209例。在风险期间，共有12名 895人(20.7%)暴露于SCS。在所有新冠肺炎结果中，暴露于SC的发病率比未暴露的发生率更高。与接种了≥1疫苗的干细胞相比，暴露于没有接种新冠肺炎疫苗的干细胞时，所有新冠肺炎结局的发病率也增加了。在调整后的模型中，干细胞与新冠肺炎感染的风险增加(HR，3.57；95%可信区间，3.24-3.93；P<；0.0001)、住院(HR，2.75；95%CI，2.07-3.65；P<；0.0001)和死亡(HR，2.49；95%CI 1.29-4.82；P=0.007)相关。SC剂量的递增与所有结果的更大风险相关。抗风湿药物降低感染风险(HR，0.84；95%CI，0.74~0.96；P=0.0 1)；肿瘤坏死因子-α抑制剂与感染风险增加(HR，1.18；95%CI，1.0 1~1.39；P=0.0 4)。在新冠肺炎疫苗广泛接种的时代，系统性皮质类固醇暴露仍然与新冠肺炎感染、住院和死亡的风险增加相关。接受免疫抑制治疗的未接种疫苗的人有更大的严重后果风险。应大力鼓励这些患者接种2019年冠状病毒病疫苗。专有或商业披露可在本文末尾的脚注和披露中找到。
To determine the risk of coronavirus disease 2019 (COVID-19) infection, hospitalization, and death in the era of COVID-19 vaccination among patients with noninfectious uveitis (NIU) taking immunosuppressive therapies. Retrospective cohort study from July 1, 2021, to June 30, 2022, using data from the Optum Labs Data Warehouse (OLDW) de-identified claims database. Patients with a diagnosis of NIU from January 1, 2017, and who had ≥ 1 year of continuous enrollment in the OLDW. Incidence rates (IRs) were calculated for each COVID-19 outcome. Unadjusted and adjusted hazard ratios (HRs) were estimated for each variable and COVID-19 outcome using Cox proportional hazards models with time-updated dichotomous indicators for outpatient immunosuppressive medication exposure. To assess the dose-dependent effect of systemic corticosteroid (SC) exposure, the average daily dose of prednisone over the exposed interval was included in the adjusted models. Hazard ratios and IRs for COVID-19 infection, hospitalization, and death. This study included 62 209 patients with NIU. A total of 12 895 (20.7%) were exposed to SCs during the risk period. Incidence rates were increased when exposed to SCs versus unexposed for all COVID-19 outcomes. Incidence rates were also increased for all COVID-19 outcomes when exposed to SCs without COVID-19 vaccination versus exposed to SCs with ≥ 1 vaccination. In adjusted models, SCs were associated with increased risk of COVID-19 infection (HR, 3.57; 95% confidence interval [CI], 3.24–3.93; P < 0.0001), hospitalization (HR, 2.75; 95% CI, 2.07–3.65; P < 0.0001), and death (HR, 2.49; 95% CI 1.29–4.82; P = 0.007). Incremental increases in SC dose were associated with a greater risk for all outcomes. Disease-modifying anti-rheumatic drugs were associated with a decreased risk of infection (HR, 0.84; 95% CI, 0.74–0.96; P = 0.01), and tumor necrosis factor-α inhibitors were associated with an increased risk of infection (HR, 1.18; 95% CI, 1.01–1.39; P = 0.04). Systemic corticosteroid exposure continues to be associated with greater risk of COVID-19 infection, hospitalization, and death among patients with NIU in an era of widespread COVID-19 vaccination. Unvaccinated individuals who are exposed to immunosuppressive treatments have a greater risk of severe outcomes. Coronavirus disease 2019 vaccination should be strongly encouraged in these patients. Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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