Background Prevalence and outcomes of coronavirus disease (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis. Methods The study was conducted in the arthritis outpatient clinic at two large academic hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence of severe acute respiratory syndrome-coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness (fever and/or cough and/or dyspnea), administered face-to-face or by phone to consecutive patients from 25 February to 20 April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 development was evaluated. Results The study population included 2050 adults with chronic inflammatory arthritis receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04–1.44] to 3.20 [1.97–5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18–1.21] to 0.47 [0.46–0.48]). No independent effects of csDMARDs, age, sex, and comorbidities were observed. Conclusions During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection. Trial registration Retrospectively registered. Not applicable.
【저자키워드】 COVID-19, SARS-CoV-2, Rheumatic diseases, Biologic drugs, Glucocorticoids, 【초록키워드】 Treatment, coronavirus disease, Arthritis, Glucocorticoids, coronavirus, hospital, Infection, Comorbidities, Comorbidity, Sex, drug, outcome, medications, Italy, cough, glucocorticoid, Prevalence, Severe acute respiratory syndrome, Nasopharyngeal swab, COVID-19 outbreak, nasopharyngeal, low-dose, Fever, Dyspnea, Patient, Inflammatory arthritis, age, large cohort, respiratory, Immunosuppressive agents, Immune-mediated, COVID-19 cases, cross-sectional survey, lombardy, Safe, criteria, Health Organization, dyspnea), not applicable, Chronic inflammatory arthritis, World Health Organization, Definition, Coronavirus Disease (COVID)-19, acute respiratory syndrome, Trial registration, acute respiratory illness, arthritis outpatient clinic, Background Prevalence, consecutive patients, csDMARDs, highly suspicious infection, immunomodulatory medications, increased risk, Laboratory-confirmed COVID-19, reduced risk, study population, World Health Organization criteria, COVID-19 case, Registered, Administered, Effect, independent, endemic area, Occurrence, Result, defined, evaluated, conducted, receiving, adjusted, appear, immunosuppressive agent, were recorded, consecutive patient, immunomodulatory medication, medications on COVID-19, patients treated, 【제목키워드】 Corticosteroid, Arthritis, Impact, Patient, immunosuppressive therapy, symptomatic SARS-CoV-2 infection,