key: cord-0025445-zkiivnx5
authors: Lee, Kevin P.; Koshelev, Misha V.; Pacha, Omar
title: The effect of biologic therapy for immune-mediated inflammatory diseases on clinical outcomes of COVID-19 in the Greater Houston Area: a retrospective chart review
date: 2022-01-10
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2021.12.054
sha: f77e0b3de3bdd0166102e487a57329bfd1b8b429
doc_id: 25445
cord_uid: zkiivnx5

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Scrutiny of biologic use has increased in light of the COVID-19 pandemic. The American 2 Academy of Dermatology and other professional organizations currently recommend 3 discontinuation of biologics in COVID-19 positive patients. 1 We performed a retrospective chart 4 review to evaluate whether patients on biologics for immune-mediated inflammatory diseases 5 (IMID) in the Greater Houston Area (GHA) were more likely to test positive and have worse 6 outcomes (hospitalization and death). 7

Demographic and clinical data were analyzed on patients receiving immunomodulatory 8 biologics for IMID between November 1, 2019 and November 15, 2020. Charts of confirmed 9 COVID-19 patients were examined for hospitalization, ICU admission, mechanical ventilation, 10 and death which were compared to GHA. GHA population and demographic data were obtained 11 through the Census Bureau. (1.5%) tested positive for COVID-19. Among these 73 patients, 16 (21.9%) were hospitalized 20 and 3 (4.1%) died. Hospitalized patients were older and more likely to be taking anti-CD20 21 biologics (31.25%) compared to the ambulatory group (5.3%) (Table S1) . 22

Our study cohort had a significantly greater proportion of female, white, and obese 23 patients compared to the GHA (P<0.0001) ( Table 2 ). The COVID-19 positivity rate in our study 24 cohort (1.5%) was significantly decreased (P<0.0001) compared to the positivity rate in GHA 25 (3.4%). In patients who were confirmed COVID-19 positive, the study cohort (21.9%) had a 26 significantly higher hospitalization rate (P=0.045) compared to the GHA (12.0%). There was no 27 significant difference in the death rate of the study cohort and GHA. 28

Anti-CD20 was the only drug category with a statistically significant increased risk of 29 COVID-19 infection and hospitalization (Table S2 ). There were no statistically significant 30 changes in COVID-19 susceptibility based on race or gender. However, obese patients were 31

found to be significantly more susceptible to COVID-19 compared to patients with a normal or 32 low BMI. 33

Our study adds to the body of evidence that patients on biologics are not at increased risk 34 of contracting COVID-19 or having worse outcomes except for rituximab which has been shown 35 to increase hospitalization rate. 4 In fact, our results suggest that patients on biologics have a 36 lower rate of COVID-19 positivity than the GHA population suggesting a possible protective 37 effect. Furthermore, biologics have been shown to decrease hospital admission rates among 38 COVID-19 patients possibly by attenuating cytokine storm. 5 Although our analysis was limited 39 in sample size, our population size was comparable to or larger than most available studies. 40

Emerging data, including our findings, and the availability of effective vaccines behooves us to 41 reconsider guidelines reflecting the relative safety of biologics. J o u r n a l P r e -p r o o f

American Academy of Dermatology. Guidance on the use of immunosuppressive agents

The authors would like to thank Fatima Ashraf and Sara Ruppelt for their assistance in obtaining the patient electronic medical record data.J o u r n a l P r e -p r o o f