Inflammatory Disease Patients on Biologics Practice More COVID-19 Shielding

Dr. Mark Yates

Social distancing and other coronavirus 2019 (COVID-19) risk-mitigating behaviors may be critical to the reduced risk of severe outcomes among infected patients with immune-mediated inflammatory diseases (IMIDs) receiving biologics.

In new data presented at the American College of Rheumatology (ACR) Convergence 2020 this week, a team of UK-based investigators reported that patients with IMID vulnerable to more severe COVID-19 outcomes due to their treatment regimen benefitted greatly from public efforts to “shield” viral transmission.

Investigators, led by Dr. Mark Yates, of King’s College London, now advocate for emphasized communication between rheumatologists and their patients on COVID-19 risk-mitigating behavior.

Yates and colleagues sought to observe COVID-19 shielding behavior benefit for patients with IMID through global patient survey data, conducted two-fold: a determined association of immunosuppressant treatment type, and a characterization of international variation.

As they noted, data suggest biologic use among such patients has been associated with a lower risk of adverse COVID-19 outcomes versus no treatment at all. That said, little to no analyses have observed the role of potentially confounding risk-mitigating behaviors in such a distinction.

“Given the variation in public health messaging between countries, it is possible that risk mitigating behavior in people with IMIDs will also vary, but this has not been explored to date,” they wrote.

The team observed completed online survey data from a pool of UK patients with rheumatic disease, as well as global patients with psoriasis, between May 20 and September 7 this year. Data entailed patient diagnosis, treatment types, demographics, and COVID-19 risk-mitigating behaviors.

Associations between treatment type and the most stringent risk-mitigating behavior was assessed through multiple logistic regression analyses. “Shielding” was defined by investigators as quarantine, staying home, or distancing from within home. Investigators adjusted for clinical and demographic characteristics.

Their pool included 3714 survey participants from 74 countries. Among them, 2259 (60.8%) reported following the most stringent risk-mitigating behavior of shielding. Biologic use was associated with greater rates of shielding among patients with IMID than among those taking no systemic therapy (OR, 1.65, 95% CI, 1.32-2.07) and standard systemic therapy (OR, 1.37; 95% CI, 1.23-1.52).

Shielding was associated with established risk factors for severe COVID-19, including male sex (OR, 1.13; 95% CI, 1.02-1.25), obesity (OR, 1.46; 95% CI, 1.32-1.62), comorbidity burden (OR, 1.45; 95% CI, 1.21-1.75), rheumatic disease (OR, 1.36; 95% CI, 1.26-1.47), and positive screenings for anxiety or depression (OR, 1.58; 95% CI, 1.38-1.80).

Investigators concluded that greater rates of shielding among patients with IMIDs receiving biologic care could contribute to an observed lessened risk of adverse outcomes due ot COVID-19.

“The observed variation in shielding among treatment groups reinforces the need for clear patient communication on risk mitigation strategies,” they wrote. “The findings help inform how clinicians discuss COVID-19 risks with vulnerable patients and will inform public health guidelines as the global COVID-19 pandemic continues to unfold.”

The study, “Risk Mitigating Behavior in People with Rheumatic Diseases or Psoriasis During the COVID-19 Pandemic Differ by Immunosuppressant Treatment Type: A Patient survey Study,” was presented at ACR 2020.