Hospitalization for Coronavirus Disease 2019 in Uveitis Patients on Conventional Immunomodulatory or Biologic Therapy: Is IMT Harmful?
Investigative Ophthalmology and Visual Science
; 63(7):2230-A0526, 2022.
Article
in English
| EMBASE | ID: covidwho-2058415
ABSTRACT
Purpose:
Patients on systemic immunomodulatory therapy (IMT) for uveitis are at higher risk of infection and infectious complications. While other medical specialties have studied the safety of IMT in non-ocular, autoimmune conditions vis-à-vis coronavirus disease 2019 (COVID-19), little is known about the effects of these drugs in uveitis patients specifically. The objective of this study was to determine if uveitis patients with COVID-19 were at higher risk of hospitalization for this pandemic illness and whether systemic IMT affected this risk.Methods:
Retrospective cohort study of uveitis patients in 2020 in the United States. The Symphony health insurance claims dataset was used. Inclusion criteria were an ICD10 code for COVID-19, a code for any form of non-infectious uveitis or scleritis, and age 18 or greater. Drugs studied included methotrexate, mycophenolate, azathioprine, tacrolimus, cyclosporine, adalimumab, infliximab, tocilizumab, rituximab, and JAK, IL-17, and IL-12/23 inhibitors. The main outcome measure was adjusted odds of hospitalization for COVID19. Multivariable logistic regression was used to adjust for major risk factors for severe COVID-19 disease, including age, biological sex, cardiac, pulmonary, hepatic, and renal disease, obesity, organ transplant, stroke, and certain cancers.Results:
3,974,272 patients in the dataset were diagnosed with COVID-19 in 2020. Of these, 6389 (0.16%) had established diagnoses of uveitis or scleritis. Within the uveitis group, mean age was 54 years (SD 16), and 62% were female. 708 (11.1%) of the uveitis patients were hospitalized for COVID-19, significantly greater than the 7.3% rate amongst all adult, COVID-19-positive patients in the dataset (p < 0.001) and the CDC estimate of 7.5% for the US population in 2020 (p < 0.001). No agent showed a statistically significant effect on hospitalization. The higher rate of hospitalization in uveitis patients was partly, though not completely, explained by higher rates in uveitis-associated autoimmune conditions in the dataset as a whole.Conclusions:
Uveitis patients have a greater risk of hospitalization for COVID-19 compared with the general population. As a whole, conventional IMT and biologics do not increase the risk of COVID-19 hospitalization amongst uveitis patients infected with the virus.
adalimumab; azathioprine; biological product; cyclosporine; endogenous compound; infliximab; interleukin 12; interleukin 17; interleukin 23; Janus kinase; methotrexate; mycophenolic acid; rituximab; tacrolimus; tocilizumab; adult; cancer patient; cerebrovascular accident; cohort analysis; conference abstract; controlled study; coronavirus disease 2019; female; health insurance; heart disease; human; ICD-10; immunotherapy; kidney disease; liver disease; lung disease; major clinical study; male; malignant neoplasm; middle aged; nonhuman; obesity; outcome assessment; pandemic; retrospective study; risk factor; scleritis; surgery; transplantation; United States; uveitis; virus
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Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Investigative Ophthalmology and Visual Science
Year:
2022
Document Type:
Article
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