Epidemiology and outcomes of novel coronavirus 2019 in patients with immune-mediated inflammatory diseases

Title: Epidemiology and outcomes of novel coronavirus 2019 in patients with immune-mediated inflammatory diseases

Authors: Milena Gianfrancesco, Jinoos Yazdany, and Philip C. Robinson

LAY SUMMARY

[Mithu Maheswaranathan]

Background:

Many patients and providers have wondered whether patients with autoimmune, inflammatory disorders (called immune-mediated inflammatory disease, IMID, in this article) would be at increased risk for complications from the novel coronavirus (COVID-19).  We know patients with autoimmune or inflammatory diseases are often on medications that suppress, or decrease, the immune system and may make it harder to fight infections.

The purpose of this article was to review and analyze the research that has been published to date on disease characteristics and outcomes of COVID-19 in patients with autoimmune inflammatory diseases (immune-mediated inflammatory disease, IMID).

What was done?

This study reviewed the medical research published on over 1400 patients from the fields of Rheumatology, Gastroenterology, and Dermatology.

What was found?

Clinical Features and Outcomes

The study found similar risk factors between the general population and those with underlying autoimmune rheumatologic or inflammatory conditions.  A summary of the research for the rheumatologic diseases is shown in Table 1.

The largest studies (registries) in rheumatology and gastroenterology are summarized below:

  • Rheumatology – COVID19 Global Rheumatology Alliance Registry
    • 600 cases of 21 different rheumatologic diseases from 40 countries
    • 46% of the people were hospitalized and 9% of them died
  • Gastroenterology – SECURE-IBD Registry
    • 525 cases from over 30 countries, mostly Crohn’s Disease (59%) and ulcerative colitis (39%)
    • 30% of people were hospitalized, 3% died, and 7% had severe COVID-19.
  • Dermatology – no registry, individual studies only
    • Insufficient evidence to date.

Risk Factors and COVID19 Outcomes

Patient Risk Factors

Similar to the general population, the following are risk factors associated with worse outcomes in COVID19.  In other words, people who have these conditions are more likely to have worse outcomes from the coronavirus:

  • older age
  • other chronic medical problems
    • hypertension (high blood pressure)
    • obesity (being overweight)
    • lung disease
    • diabetes
    • heart disease (cardiovascular disease)

 

Specific Medications

Steroids appears to be a risk factor for more severe outcomes in COVID19:

  • The Rheumatology registry (COVID19-GRA) found an association between steroids and hospitalization. Patients on at least 10 mg per day of prednisone (steroid) were more likely to be hospitalized.
  • The Gastroenterology registry (SECURE-IBD) also found that being on steroids was associated with more severe COVID-19 disease, defined as intensive care unit admission, ventilator use, and/or death.

 

What does it mean?

This review of the research to date has helped us with understanding of some risk factors related to COVID19:

❶ Patients with rheumatologic diseases may not be at higher risk of getting COVID19 than patients who do not have rheumatologic disease.

❷ However, patients with an underlying rheumatologic disease may have a higher chance of having severe outcomes (such as needing to be on a ventilator or breathing machine) if they get COVID19.

❸ Being on steroid medications (such as prednisone) may be a risk factor for worse outcomes, or having more severe complications from COVID19.

It is important to note that some of these studies were only done in patients who were hospitalized with COVID19.  Because some of the research did not include patients with mild or no symptoms, they may overestimate the amount of severe disease (in other words, report higher rates of severe disease or worse outcomes) due to the patients included in the study.