Risks of COVID-19 Infection and Mortality for Patients on Biologics
Nikolai Klebanov, MD, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
Disclosures: None.
Importance
Data on the risks of immunosuppressive biologics in the context of coronavirus disease 2019 (COVID-19) infection are limited, creating uncertainty for patients and providers whether to continue therapy during the pandemic.
Objective
To investigate whether patients treated with biologics were at an increased risk for COVID-19 infection as well as all-cause mortality once infected.
Design
A multicenter retrospective study of 7361 patients prescribed biologics and 74,910 matched controls, cross-referenced with COVID-19 infection and all-cause mortality data through June 19, 2020, from the Massachusetts Department of Public Health.
Participants
Patients with at least 1 prescription for an immunosuppressive biologic in the Mass General Brigham health care system between July 1, 2019, and February 29, 2020. Multivariate logistic regression was used on matched data to calculate the odds ratio (OR) for COVID-19 infection status between patients on biologics and controls, adjusting for age, gender, race, Charlson Comorbidity index (CCI) severity grade, median income, and local infection rate. An analysis adjusting for individual comorbidities was also performed. Multivariate Poisson regression was performed on COVID-19 positive patients to compare the risk for all-cause mortality, adjusting for gender, CCI severity grade, median income, and local COVID-19 rate.
Setting
Retrospective matched cohort.
Exposure
Biologic immunosuppressants.
Main Outcomes and Measures
Odds of COVID-19 diagnosis and all-cause mortality following the diagnosis.
Results
7,361 patients treated with biologics and 74,910 matched controls were included in the analysis (mean age, 50.6 years; 56.0% women, 84.5% white; mean age-adjusted CCI 2.8). There were 87 (1.2%) infections and 7 deaths (8.0%) in patients treated with biologics and 1063 (1.4%) infections and 71 deaths (6.7%) in the control group. Patients treated with immunosuppressive biologics were not at significantly increased risk of COVID-19 diagnosis (OR 0.88, 95% CI 0.71-1.09; P=.25) or subsequent mortality (OR 1.26, 95% CI 0.57-2.76; P=.57).
A total of 7361 patients treated with biologics and 74,910 matched controls were included in the analysis (mean age, 50.6 years; 56.0% women and 84.5% white; mean age-adjusted CCI, 2.8). There were 87 (1.2%) infections and 7 deaths (8.0%) in patients treated with biologics, and 1063 (1.4%) infections and 71 deaths (6.7%) in the control group. Patients treated with immunosuppressive biologics were not at increased risk for COVID-19 diagnosis (OR, 0.88; 95% CI, 0.71-1.09; P=.25) or subsequent mortality (OR 1.26; 95% CI 0.57-2.76; P=.57).
Conclusions and Relevance
Given an absence of evidence that patients treated with biologics are more susceptible to COVID-19, patients should be encouraged to continue their therapy to prevent disease progression during this pandemic.
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