ABSTRACT
Background: Patiromer (PAT) is a sodium-free, non-absorbed potassium (K+) binder (KB) approved for the treatment of hyperkalemia (HK). HK is common in older pts with cardiorenal comorbidities and often leads to increased Healthcare Resource Utilization (HRU). Here we aim to describe electrolyte-related HRU in Veterans with HK who initiated PAT or discontinued RAAS inhibitor (RAASi DC) therapy and were not receiving a KB (1/1/2016−8/30/2018). Methods: Using retrospective, observational data, pts utilizing the hospital or ED during the 6 months (mos) prior to the index date were assessed at 1, 3, and 6 mos post-index. The index date was the date of PAT initiation or the date of RAASi DC in pts not receiving a KB (RAASi DC/no KB). All pts had a baseline serum K+ ≥5.1mEq/L and HF, DM, or non-dialysis CKD. Pts with continuous exposure (CE) to PAT and those who did not restart RAASi were analyzed. Results: 288 and 26,543 pts were included in the PAT and RAASi DC/no KB groups, respectively. Following CE to PAT at 1, 3, and 6 mos post-index, no electrolyte related ED or hospital utilization was observed. In the RAASi DC group, 2-5% of pts reutilized the ED or hospital within 6 mos (Figure). Conclusion: Of the pts who experienced an electrolyte-related hospitalization or ED visit within the 6 mos prior to PAT dispensing, no pts reutilized these services in the following 6 mos. Given the limited number of PAT users, additional investigation is warranted. Disclosure: C.P. Kovesdy: Consultant;Self;Amgen, AstraZeneca, Bayer AG, Cara Therapeutics, Reata, Takeda Pharmaceutical Company Limited, Tricida. E. Gosmanova: None. S.D. Woods: Employee;Self;Relypsa, Inc. Stock/Shareholder;Self;Vifor Pharma Group. J.J. Fogli: Employee;Self;Relypsa, Inc. Stock/Shareholder;Self;Vifor Pharma Group. C.G. Rowan: Consultant;Self;AbbVie Inc., Covidia, Halozyme, Keryx, Relypsa, Inc., Vifor Pharma Group. Other Relationship;Self;COHRDATA. J.L. Hansen: Research Support;Self;COHRDATA. B.C. Sauer: Research Support;Self;COHRDATA. Funding: Relypsa, Inc. [ABSTRACT FROM AUTHOR] Copyright of Diabetes is the property of American Diabetes Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
OBJECTIVE: Rheumatoid arthritis (RA) and its treatments are associated with an increased risk of infection, but it remains unclear whether these factors have an impact on the risk or severity of COVID-19. The present study was undertaken to assess the risk and severity of COVID-19 in a US Department of Veterans Affairs (VA) cohort of patients with RA and those without RA. METHODS: A matched cohort study using national VA data was conducted. Patients diagnosed as having RA were identified among nondeceased individuals who were active in the VA health care system as of January 1, 2020 and who had received care in a VA medical center in 2019; patients for whom no RA diagnostic code was indicated were matched to the RA patients (1:1) by age, sex, and VA site (non-RA controls). Patients diagnosed as having COVID-19 and those with severe COVID-19 (defined as requiring hospitalization or leading to death) were ascertained from a national VA COVID-19 surveillance database through December 10, 2020. Multivariable Cox models were used to compare the risk of COVID-19 and COVID-19 hospitalization or death between RA patients and non-RA controls, after adjusting for demographic characteristics, comorbidities, health care utilization and access, and county-level COVID-19 incidence rates. RESULTS: This VA cohort of RA patients and non-RA controls (n = 33,886 subjects per group) predominantly comprised male patients (84.5%), and the mean age was 67.8 years. During follow-up, 1,503 patients in the cohort were diagnosed as having COVID-19; among them, 388 patients had severe COVID-19 (hospitalization or death), while in 228 patients, the deaths were not related to COVID-19. In the multivariable model, RA was associated with a higher risk of COVID-19 (adjusted hazard ratio [HR] 1.25 [95% confidence interval (95% CI) 1.13-1.39]) and a higher risk of COVID-19 hospitalization or death (adjusted HR 1.35 [95% CI 1.10-1.66]) as compared to non-RA controls. Use of disease-modifying antirheumatic drugs and prednisone, as well as self-reported Black race, self-reported Hispanic ethnicity, and presence of several chronic conditions, but not seropositivity for RA autoantibodies, were each associated with risk of COVID-19 and severe COVID-19 (hospitalization or death). CONCLUSION: Patients with RA are at higher risk of developing COVID-19 and severe COVID-19 (leading to hospitalization or death) compared to those without RA. With a risk of COVID-19 that approaches that of other recognized chronic conditions, these findings suggest that RA patients should be prioritized for COVID-19 prevention and management strategies.