COVID-19 risk and outcomes in adult asthmatic patients treated with biologics or systemic corticosteroids: Nationwide real-world evidence - 04/08/21
, Marc Humbert, MD, PhD c, d, e, Walid Saliba, MD, MPH b, f
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Abstract |
Background |
Managing severe asthma during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging, particularly due to safety concerns regarding the use of systemic corticosteroids and biologics.
Objectives |
We sought to determine the association between biologics or systemic corticosteroids use and PCR positivity for SARS-CoV-2 and coronavirus disease 2019 (COVID-19) outcomes among asthmatic patients.
Methods |
We used the computerized database of Clalit Health Services, the largest health care provider in Israel, to identify all asthmatic adult patients who underwent PCR testing for SARS-CoV-2, between March 1, 2020, and December 7, 2020. A cohort approach was used to assess the association between biologics use and steroids treatment and COVID-19 severity and 90-day mortality.
Results |
Overall, 8,242 of 80,602 tested asthmatic patients had positive PCR testing result for SARS-CoV-2. Both biologics and systemic corticosteroids were not associated with increased risk of SARS-CoV-2 infection. Multivariate analyses revealed that biologics were not associated with a significantly increased risk of moderate to severe COVID-19, nor with the composite end point of moderate to severe COVID-19 or all-cause mortality within 90 days. Chronic systemic corticosteroid use was associated with significantly increased risk of all tested outcome. Recent (within the previous 120 days) systemic corticosteroid use, but not former use, was significantly associated with increased risk of both moderate to severe COVID-19 and the composite of moderate to severe COVID-19 or all-cause mortality.
Conclusions |
Biologics approved for asthma and systemic corticosteroids are not associated with increased risk of SARS-CoV-2 infection. In contrast, systemic corticosteroids are an independent risk factor for worst COVID-19 severity and all-cause mortality. Our findings underscore the risk of recent or current exposure to systemic corticosteroids in asthmatic patients infected with SARS-CoV-2.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Key words : COVID-19, asthma, systemic corticosteroids, biologics
Abbreviations used : COVID-19, HR, SARS-CoV-2, SCS
Plan
| Disclosure of potential conflict of interest: Y. Adir reports personal fees from Teva and Sanofi and grants and personal fees from Glaxo Smith Kline (GSK) and Astra Zeneca, outside the submitted work. M. Humbert reports personal fees from Acceleron, GSK, Merck, Novartis, Astra Zeneca, and Sanofi and grants and personal fees from Actelion and Bayer, outside the submitted work. W. Saliba has nothing to disclose. |
Vol 148 - N° 2
P. 361 - août 2021 Retour au numéro
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