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Immune-mediated inflammatory diseases do not increase the risk of COVID-19 infection

In a large European study of immunosuppressed patients, the rate of COVID-19 infection was no higher than the general population as long as systemic inflammation was controlled.

It is now widely recognised that more severe disease in COVID-19 occurs in those with associated comorbidities such as hypertension and diabetes. Moreover, concerns have been expressed that those with a dysfunctional immune system, i.e., patients with immune-mediated inflammatory diseases such as rheumatoid arthritis, also have an increased risk of a poor prognosis if infected with the virus. Indeed, one meta-analysis has estimated that patients with autoimmune diseases have more than twice the risk of infection with COVID-19. In contrast, it has been suggested that due to the systemic inflammatory response induced by COVID-19, patients prescribed treatments aimed at controlling inflammation, may be protected against more severe disease. In an effort to understand more about how COVID-19 impacts upon those with immune-mediated inflammatory conditions, the Euro-COVIMID study was undertaken. This cross-sectional study, followed-up patients in six European countries with one of several immune-related inflammatory disorders including rheumatoid arthritis, systemic lupus erythematosus and Sjogren’s syndrome. Data were collected on demographics, comorbidities, number of recent disease flares and the presence of COVID-19 in a questionnaire completed in consultation with a healthcare professional when the patient was seen at an outpatient clinic. The primary outcome of the study was the prevalence of serological and clinical COVID-19 although the authors also sought to understand which, if any factors, were associated with a worse prognosis.

Data were available for 3038 patients with a mean age of 58 years (73.9% female). The most common immune disease was rheumatoid arthritis (29.4%), axial spondylarthritis (22.1%) and systemic lupus erythematosus (20%). Nearly a third (32%) of patients were taking oral prednisolone and 35.9% were prescribed a biological or synthetic DMARD. Comorbidities included hypertension (29.7%), dyslipidaemia (13.6%) and obesity (8.1%).

COVID-19 antibodies were detected in 5.5% of patients and symptomatic COVID-19 occurred in 122 (4%) of whom, 24 were hospitalised and 4 died. Factors significantly associated with symptomatic COVID-19 included higher plasma levels of C-reactive protein, CRP (odds ratio, OR = 1.18, 95% CL 1.05 – 1.33, p = 0.006) and a higher number of disease flares (OR = 1.27). In contrast, the use of biological therapy was associated with a reduced risk (OR = 0.51) of symptomatic COVID-19.

In their discussion, the authors noted that the prevalence of COVID-19 among those with immune-mediated inflammatory diseases was no higher than in the general population. They also speculated that the presence of elevated CRP levels, representing systemic inflammation, might contribute towards the development of COVID-19 and that biological therapy, which effectively dampened systemic inflammation, appeared to exert a protective effect. The authors concluded that adequate control of inflammatory activity in those immune-mediated diseases could be crucial during the COVID-19 pandemic.

Saasoun D et al. SARS-CoV-2 outbreak in immune-mediated inflammatory diseases: the Euro-COVIMID multi-centre cross-sectional study. Lancet Rheumatol 2021

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