Background: The disease caused by SARS-CoV-2 is a potentially serious infection. The autoimmune and immune-mediated inflammatory disease (AI/IMID) itself, its activity, the immunosuppression and the presence of comorbidities are associated with an increased risk of serious infections. At this moment the literature shows a similar risk of infection and severity compared to the general population. Some reports noted that these patients might adopt stricter measures of self-care protection than general population which could contribute to an incidence of infection lower than expected.
Objectives: To assess the incidence and clinical presentation of SARS-CoV-2 infection in our cohort of patients with AI/IMID treated with biological agents (BA) or Janus Kinasa (JAK) inhibitors. To analyse the association of the incidence and the type of confinement between the AI/IMID group and the general population.
Methods: A case-control study nested within a retrospective observational study was conducted from March 13th until April 23th, 2020 in Althaia, Xarxa Assistencial Universitària de Manresa. Subjects: cohort of AI/IMID patients followed by Rheumatology (inflammatory arthritis), Dermatology (psoriasis) and Digestology (inflammatory bowel disease) treated with BA/JAK inhibitors. Controls were selected from our Primary Care Centers. Main outcome: Type of confinement: strict: <1 outing / week with safety measures (SM), regular (2-3 outings with SM), lax (> 3 outings or face-to-face work with SM) and without confinement (without SM). Secondary outcome: SARS-CoV-2 infection: confirmed (PCR and/or positive serology), probable (severe illness requiring admission without PCR/serology or mild moderate with epidemiological contact) and possible (mild infection without microbiological check nor epidemiological contact); as well as severity according to the WHO.
Results: 367 patients and 193 controls were included. 45.2% of patients were men, with a mean age of 52 (SD 14.6). 47.4% were patients with rheumatologic disease, 25.3% from dermatology and 27.2% from digestive. 95.6% received a BA (66.6% anti-TNF and 33.4% non-anti-TNF) and the remaining 4.4% received JAK inhibitors. 43.3% patients had at least a risk factor compared to 37.8% in the control group (p=0.761). The Table 1 shows the incidence of COVID divided into confirmed and cumulative cases (confirmed and possible), with no significant differences. One patient (0.3%) in the case group and 3 patients (1.6%) in the control group required hospital admission (p=0.121). In relation to the type of confinement we had significant differences (p=0.013) within the AI/IMID group versus the control group in lax confinement. There were no differences in the incidence of COVID between the different confinement types.
Conclusion: The incidence of COVID-19 infection in our cohort is similar to that reported in other series of AI/IMID patients and in general population, both for confirmed cases (3.3% vs 5.7%) as well as for cumulative cases (10.1% vs 13.5%). None of our patients developed a severe form of the infection. We observed that strict confinement was predominant in both groups, being higher in the AI/IMID patients (59.1% vs 50.3%). Furthermore, lax confinement was more frequent in the control group. Although the difference was not statistically significant, the incidence of infection was higher in the control group, especially in the subjects who performed lax confinement.
Disclosure of Interests: None declared.
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