Abstract：
BACKGROUND: Patients taking immune-suppressive drugs are at increased risk of severe coronavirus disease 2019 (COVID-19), not fully ameliorated by vaccination. We assessed the contributions of clinical and demographic factors to the risk of severe disease despite vaccination in patients taking immune-suppressive medications for solid organ transplantation (SOT), rheumatoid arthritis (RA), inflammatory bowel disease (IBD), or psoriasis.
METHODS: Veterans Health Administration electronic health records were used to identify patients diagnosed with RA, IBD, psoriasis, or SOT who had been vaccinated against severe acute respiratory syndrome coronavirus 2, were subsequently infected, and had received immune-suppressive drugs within 3 months before infection. The association of severe (defined as hypoxemia, mechanical ventilation, dexamethasone use, or death) versus non-severe COVID-19 with the use of immune-suppressive and antiviral drugs and clinical covariates was assessed by multivariable logistic regression.
RESULTS: Severe COVID-19 was more common in patients with SOT (230/1011, 22.7%) than RA (173/1355, 12.8%), IBD (51/742, 6.9%), or psoriasis (82/1125, 7.3%). Age was strongly associated with severe COVID-19, adjusted odds ratio (aOR) of 1.04 (CI 1.03-1.05) per year. Comorbidities indicating chronic brain, heart, lung, or kidney damage were also associated with severity, aOR 1.35-2.38. The use of glucocorticoids was associated with increased risk (aOR 1.66, CI 1.39-2.18). Treatment with antivirals was associated with reduced severity, for example, aOR 0.28 (CI 0.13-0.62) for nirmatrelvir/ritonavir.
CONCLUSIONS: The risk of severe COVID-19 despite vaccination is substantial in patients taking immune-suppressive drugs, more so in patients with SOT than in patients with inflammatory diseases. Age and severe comorbidities contribute to risk, as in the general population. Oral antivirals were very beneficial but not widely used.
METHODS: Veterans Health Administration electronic health records were used to identify patients diagnosed with RA, IBD, psoriasis, or SOT who had been vaccinated against severe acute respiratory syndrome coronavirus 2, were subsequently infected, and had received immune-suppressive drugs within 3 months before infection. The association of severe (defined as hypoxemia, mechanical ventilation, dexamethasone use, or death) versus non-severe COVID-19 with the use of immune-suppressive and antiviral drugs and clinical covariates was assessed by multivariable logistic regression.
RESULTS: Severe COVID-19 was more common in patients with SOT (230/1011, 22.7%) than RA (173/1355, 12.8%), IBD (51/742, 6.9%), or psoriasis (82/1125, 7.3%). Age was strongly associated with severe COVID-19, adjusted odds ratio (aOR) of 1.04 (CI 1.03-1.05) per year. Comorbidities indicating chronic brain, heart, lung, or kidney damage were also associated with severity, aOR 1.35-2.38. The use of glucocorticoids was associated with increased risk (aOR 1.66, CI 1.39-2.18). Treatment with antivirals was associated with reduced severity, for example, aOR 0.28 (CI 0.13-0.62) for nirmatrelvir/ritonavir.
CONCLUSIONS: The risk of severe COVID-19 despite vaccination is substantial in patients taking immune-suppressive drugs, more so in patients with SOT than in patients with inflammatory diseases. Age and severe comorbidities contribute to risk, as in the general population. Oral antivirals were very beneficial but not widely used.
摘要：
背景：服用免疫抑制药物的患者患严重冠状病毒病2019（COVID-19）的风险增加，疫苗接种没有完全改善。我们评估了临床和人口统计学因素对严重疾病风险的贡献，尽管在服用免疫抑制药物进行实体器官移植（SOT）的患者中接种了疫苗，类风湿性关节炎(RA),炎症性肠病（IBD），或牛皮癣。
方法：使用退伍军人健康管理局电子健康记录来识别诊断为RA的患者，IBD,牛皮癣,或SOT接种了严重急性呼吸道综合症冠状病毒2疫苗，随后被感染，并在感染前3个月内接受过免疫抑制药物治疗。严重（定义为低氧血症，机械通气,地塞米松使用,或死亡）与使用免疫抑制和抗病毒药物和临床协变量的非重度COVID-19相比，通过多变量逻辑回归评估。
结果：重度COVID-19在SOT患者中（230/1011，22.7%）比RA患者（173/1355，12.8%）更常见，IBD（51/742，6.9%），或银屑病（82/1125，7.3%）。年龄与严重COVID-19密切相关，校正比值比（aOR）为每年1.04（CI1.03-1.05）。合并症表明慢性大脑，心,肺，或肾脏损害也与严重程度有关，OR1.35-2.38。糖皮质激素的使用与风险增加相关（aOR1.66，CI1.39-2.18）。抗病毒药物治疗与严重程度降低相关，例如,nirmatrelvir/利托那韦的OR0.28(CI0.13-0.62)。
结论：在服用免疫抑制药物的患者中，尽管接种了疫苗，但严重COVID-19的风险仍然很大，SOT患者比炎性疾病患者更多。年龄和严重的合并症会导致风险，就像普通人群一样。口服抗病毒药物非常有益，但未广泛使用。
方法：使用退伍军人健康管理局电子健康记录来识别诊断为RA的患者，IBD,牛皮癣,或SOT接种了严重急性呼吸道综合症冠状病毒2疫苗，随后被感染，并在感染前3个月内接受过免疫抑制药物治疗。严重（定义为低氧血症，机械通气,地塞米松使用,或死亡）与使用免疫抑制和抗病毒药物和临床协变量的非重度COVID-19相比，通过多变量逻辑回归评估。
结果：重度COVID-19在SOT患者中（230/1011，22.7%）比RA患者（173/1355，12.8%）更常见，IBD（51/742，6.9%），或银屑病（82/1125，7.3%）。年龄与严重COVID-19密切相关，校正比值比（aOR）为每年1.04（CI1.03-1.05）。合并症表明慢性大脑，心,肺，或肾脏损害也与严重程度有关，OR1.35-2.38。糖皮质激素的使用与风险增加相关（aOR1.66，CI1.39-2.18）。抗病毒药物治疗与严重程度降低相关，例如,nirmatrelvir/利托那韦的OR0.28(CI0.13-0.62)。
结论：在服用免疫抑制药物的患者中，尽管接种了疫苗，但严重COVID-19的风险仍然很大，SOT患者比炎性疾病患者更多。年龄和严重的合并症会导致风险，就像普通人群一样。口服抗病毒药物非常有益，但未广泛使用。
