Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis.
Impact of corticosteroids and immunosuppressive therapies on symptomatic SARS-CoV-2 infection in a large cohort of patients with chronic inflammatory arthritis.
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DOI：
10.1186/s13075-020-02395-6
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发表时间：
2020-12-30
影响因子：
4.9
通讯作者：
Montecucco C
中科院分区：
文献类型：
--
作者：
Favalli EG;Bugatti S;Klersy C;Biggioggero M;Rossi S;De Lucia O;Bobbio-Pallavicini F;Murgo A;Balduzzi S;Caporali R;Montecucco C
与免疫调节药物相关的冠状病毒病（COVID）-19的患病率和结局仍然未知。该研究的目的是在一个大型慢性免疫介导的炎症性关节炎患者队列中研究糖皮质激素和免疫抑制剂对COVID-19的影响。该研究在北方意大利（伦巴第大区）COVID-19流行最严重地区的两家大型学术医院的关节炎门诊进行。我们在2020年2月25日至4月20日期间，通过面对面或电话对连续患者进行了一项横断面调查，以探索严重急性呼吸道综合征-冠状病毒2型鼻咽拭子阳性的患病率和急性呼吸道疾病（发热和/或咳嗽和/或呼吸困难）的发生率。根据世界卫生组织的标准，COVID-19病例被定义为确诊或高度可疑。评估了药物对COVID-19发展的影响。研究人群包括2050名接受糖皮质激素、常规合成（cs）或靶向合成/生物（ts/B）疾病缓解药物（DMARD）治疗的慢性炎性关节炎成人。确诊的COVID-19和高度可疑感染分别占人口的1. 1%和1. 4%。糖皮质激素治疗与COVID-19风险增加独立相关（调整后的OR [95%CI]范围为1.23 [1.04-1.44]至3.20 [1.97-5.18]，取决于所用的定义）。相反，接受ts/bDMARD治疗的患者风险降低（校正OR范围为0.46 [0.18-1.21]至0.47 [0.46-0.48]）。未观察到csDMARD、年龄、性别和合并症的独立影响。在COVID-19爆发期间，免疫调节药物治疗似乎是安全的。相反，糖皮质激素，即使是低剂量，也可能增加感染的风险。已登记的逆行。不适用因
Prevalence and outcomes of coronavirus disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis. The study was conducted in the arthritis outpatient clinic at two large academic hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of severe acute respiratory syndrome-coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25 February to 20 April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 development was evaluated. The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04–1.44] to 3.20 [1.97–5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18–1.21] to 0.47 [0.46–0.48]). No independent effects of csDMARDs, age, sex, and comorbidities were observed. During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection. Retrospectively registered. Not applicable.
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影响因子：
158.5
作者：
Boulware, David R.;Pullen, Matthew F.;Hullsiek, Kathy H.
通讯作者：
Hullsiek, Kathy H.
影响因子：
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