COVID-19 outcomes among autoimmune patients receiving immunomodulatory therapy
| Autoimmune cohort | ||||||||
| Anti-TNF* biologic with/without DMARDs† and/or corticosteroids (n=16) | Biologic‡ (non-TNF) with/without DMARDs and/or corticosteroids (n=15) | Non-biologic DMARDs alone (n=11) | Non-biologic DMARDs and corticosteroids (n=3) | Corticosteroids§ alone (n=9) | JAK inhibitor¶ (n=3) | Other**immune-modulatory therapy with/without DMARDs and/or corticosteroids (n=11) | Post solid organ transplant (n=13) | |
| Female (%) | 56.3 | 66.7 | 81.8 | 66.7 | 33.3 | 66.7 | 72.7 | 15.4 |
| Median age, years | 59 (27–81) | 54 (26–79) | 70 (38–84) | 62 (52–68) | 54 (34–62) | 63 (49–63) | 62 (16–71) | 58 (46–74) |
| Comorbidities (%) | ||||||||
| Hypertension | 37.5 | 20.0 | 36.4 | 66.7 | 11.1 | 0.0 | 36.4 | 61.5 |
| Diabetes | 12.5 | 6.7 | 36.4 | 0.0 | 11.1 | 0.0 | 27.3 | 69.2 |
| Indication for immunosuppressive (%) | ||||||||
| Rheumatoid arthritis | 56.3 | 20.0 | 54.6 | 33.3 | 0.0 | 33.3 | 9.1 | N/A |
| IBD†† | 31.3 | 0.0 | 36.4 | 33.3 | 22.2 | 66.7 | 9.1 | N/A |
| Sarcoidosis | 6.3 | 0.0 | 0.0 | 33.3 | 33.3 | 0.0 | 9.1 | N/A |
| COVID-19 Treatment‡‡ (%) | ||||||||
| Azithromycin | 0.0 | 6.7 | 9.1 | 0.0 | 0.0 | 33.3 | 27.3 | 30.8 |
| Hydroxychloroquine | 6.3 | 46.7 | 18.2§§ | 66.7 | 22.2 | 33.3 | 45.5 | 61.5 |
| Tocilizumab | 0.0 | 20.0 | 9.1 | 0.0 | 44.4 | 0.0 | 9.1 | 15.4 |
| Baseline immunomodulatory treatment (%) | ||||||||
| Unchanged | 18.8 | 60.0 | 45.5 | 33.3 | 100.0 | 66.7 | 45.5 | 53.9 |
| Modified | 75.0 | 40.0 | 54.6¶¶ | 33.3 | 0.0 | 33.3 | 45.5 | 46.2 |
| Unknown | 6.3 | 0.0 | 0.0 | 33.3 | 0.0 | 0.0 | 9.1 | 0.0 |
| Outcome (%) | ||||||||
| Hospitalised | 50.0 | 73.3 | 90.9 | 100.0 | 100.0 | 66.7 | 81.8 | 100.0 |
| Intensive care unit | 6.3 | 53.3 | 27.3 | 66.7 | 77.8 | 33.3 | 63.6 | 61.5 |
| Ventilator support | 0.0 | 40.0 | 9.1 | 66.7 | 66.7 | 33.3 | 45.5 | 46.2 |
| Deceased*** | 0.0 | 13.3 | 18.2 | 33.3 | 11.1 | 0.0 | 18.2 | 7.7 |
*Anti tumour necrosis factor (TNF) therapy includes (n): adalimumab (5), certolizumab (1), etanercept (7), golimumab (1), infliximab (2). Adalimumab, etanercept and infliximab biosimilars included.
†Non-biologic disease-modifying antirheumatic drugs (DMARDs) with/without immunomodulatory therapy (n): balsalazide (2), hydroxychloroquine (5), leflunomide (1), mesalamine (1), methotrexate (12) or sulfasalazine (2).
‡Non-TNF biologic therapy includes (n): abatacept (2), anakinra (1), dupilumab (1), ocrelizumab (1), omalizumab (1), rituximab (6), secukinumab (1) or tocilizumab (2).
§Corticosteroids include (n): prednisone (5) or inhaled steroids (4); n=26 for total prednisone use with/without immunomodulatory therapy, median daily dose 15 mg (2–60 mg).
¶Janus kinase (JAK) inhibitors include (n): tofacitinib (2) and upadacitinib (1); both tofacitinib patients continued dosing as prescribed.
**Other immunomodulatory therapy includes (n): azathioprine (2), cyclosporine (1), cyclophosphamide (1), fingolimod (2), interferon beta-1b (1), mycophenolate (3) and tacrolimus (2) includes Crohn's disease and ulcerative colitis.
††Inflammatory bowel disease (IBD) includes Crohn's disease and ulcerative colitis.
‡‡Treatment groups are not mutually exclusive
§§Mutually exclusive from patients with baseline hydroxychloroquine use
¶¶Among those on methotrexate alone (n=5), 80% modified treatment
***Deceased by drug (n): azathioprine (1), balsalazide (1), cyclosporine and prednisone (1), rituximab and prednisone (2), methotrexate alone (1), prednisone alone (1), methotrexate and prednisone (1), and mycophenolate, tacrolimus and prednisone (1).