■为了确定2019年冠状病毒病(COVID-19)感染的风险,住院治疗,在COVID-19疫苗接种时代,服用免疫抑制疗法的非感染性葡萄膜炎(NIU)患者死亡。
■2021年7月1日至2022年6月30日的回顾性队列研究,使用OptumLabs数据仓库(OLDW)去识别索赔数据库的数据。
■从2017年1月1日起诊断为NIU的患者,并且在OLDW连续登记≥1年。
■计算每个COVID-19结果的发病率(IR)。使用Cox比例风险模型和门诊免疫抑制药物暴露的时间更新的二分指标估计每个变量和COVID-19结果的未调整和调整的风险比(HR)。评估全身皮质类固醇(SC)暴露的剂量依赖性效应,校正后的模型中包括了暴露间隔内泼尼松的平均日剂量.
■COVID-19感染的危险比和IRs,住院治疗,和死亡。
■这项研究包括62209例NIU患者。共有12895人(20.7%)在风险期内暴露于SCs。在所有COVID-19结果中,暴露于SCs的发生率均高于未暴露的发生率。当暴露于无COVID-19疫苗接种的SCs与暴露于≥1疫苗接种的SCs相比,所有COVID-19结局的发病率也增加。在调整后的模型中,SCs与COVID-19感染风险增加相关(HR,3.57;95%置信区间[CI],3.24-3.93;P<0.0001),住院(HR,2.75;95%CI,2.07-3.65;P<0.0001),和死亡(HR,2.49;95%CI1.29-4.82;P=0.007)。SC剂量的增加与所有结果的更大风险相关。改善疾病的抗风湿药物与感染风险降低相关(HR,0.84;95%CI,0.74-0.96;P=0.01),和肿瘤坏死因子-α抑制剂与感染风险增加相关(HR,1.18;95%CI,1.01-1.39;P=0.04)。
■全身性皮质类固醇暴露继续与COVID-19感染的更大风险相关,住院治疗,在广泛接种COVID-19的时代,NIU患者的死亡。暴露于免疫抑制治疗的未接种疫苗的个体具有更大的严重后果的风险。应大力鼓励这些患者接种2019年冠状病毒疾病疫苗。
■专有或商业披露可在本文末尾的脚注和披露中找到。
UNASSIGNED: To determine the risk of coronavirus disease 2019 (COVID-19) infection, hospitalization, and death in the era of COVID-19 vaccination among patients with noninfectious uveitis (NIU) taking immunosuppressive therapies.
UNASSIGNED: Retrospective cohort study from July 1, 2021, to June 30, 2022, using data from the Optum Labs Data Warehouse (OLDW) de-identified claims database.
UNASSIGNED: Patients with a diagnosis of NIU from January 1, 2017, and who had ≥ 1 year of continuous enrollment in the OLDW.
UNASSIGNED: Incidence rates (IRs) were calculated for each COVID-19 outcome. Unadjusted and adjusted hazard ratios (HRs) were estimated for each variable and COVID-19 outcome using Cox proportional hazards models with time-updated dichotomous indicators for outpatient immunosuppressive medication exposure. To assess the dose-dependent effect of systemic corticosteroid (SC) exposure, the average daily dose of prednisone over the exposed interval was included in the adjusted models.
UNASSIGNED: Hazard ratios and IRs for COVID-19 infection, hospitalization, and death.
UNASSIGNED: This study included 62 209 patients with NIU. A total of 12 895 (20.7%) were exposed to SCs during the risk period. Incidence rates were increased when exposed to SCs versus unexposed for all COVID-19 outcomes. Incidence rates were also increased for all COVID-19 outcomes when exposed to SCs without COVID-19 vaccination versus exposed to SCs with ≥ 1 vaccination. In adjusted models, SCs were associated with increased risk of COVID-19 infection (HR, 3.57; 95% confidence interval [CI], 3.24-3.93; P < 0.0001), hospitalization (HR, 2.75; 95% CI, 2.07-3.65; P < 0.0001), and death (HR, 2.49; 95% CI 1.29-4.82; P = 0.007). Incremental increases in SC dose were associated with a greater risk for all outcomes. Disease-modifying anti-rheumatic drugs were associated with a decreased risk of infection (HR, 0.84; 95% CI, 0.74-0.96; P = 0.01), and tumor necrosis factor-α inhibitors were associated with an increased risk of infection (HR, 1.18; 95% CI, 1.01-1.39; P = 0.04).
UNASSIGNED: Systemic corticosteroid exposure continues to be associated with greater risk of COVID-19 infection, hospitalization, and death among patients with NIU in an era of widespread COVID-19 vaccination. Unvaccinated individuals who are exposed to immunosuppressive treatments have a greater risk of severe outcomes. Coronavirus disease 2019 vaccination should be strongly encouraged in these patients.
UNASSIGNED: Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.