Background

Managing severe asthma during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging, particularly due to safety concerns regarding the use of systemic corticosteroids and biologics.

Objectives

We sought to determine the association between biologics or systemic corticosteroids use and PCR positivity for SARS-CoV-2 and coronavirus disease 2019 (COVID-19) outcomes among asthmatic patients.

Methods

We used the computerized database of Clalit Health Services, the largest health care provider in Israel, to identify all asthmatic adult patients who underwent PCR testing for SARS-CoV-2, between March 1, 2020, and December 7, 2020. A cohort approach was used to assess the association between biologics use and steroids treatment and COVID-19 severity and 90-day mortality.

Results

Overall, 8,242 of 80,602 tested asthmatic patients had positive PCR testing result for SARS-CoV-2. Both biologics and systemic corticosteroids were not associated with increased risk of SARS-CoV-2 infection. Multivariate analyses revealed that biologics were not associated with a significantly increased risk of moderate to severe COVID-19, nor with the composite end point of moderate to severe COVID-19 or all-cause mortality within 90 days. Chronic systemic corticosteroid use was associated with significantly increased risk of all tested outcome. Recent (within the previous 120 days) systemic corticosteroid use, but not former use, was significantly associated with increased risk of both moderate to severe COVID-19 and the composite of moderate to severe COVID-19 or all-cause mortality.

Conclusions

Biologics approved for asthma and systemic corticosteroids are not associated with increased risk of SARS-CoV-2 infection. In contrast, systemic corticosteroids are an independent risk factor for worst COVID-19 severity and all-cause mortality. Our findings underscore the risk of recent or current exposure to systemic corticosteroids in asthmatic patients infected with SARS-CoV-2.

中文翻译：

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接受生物制剂或全身性皮质类固醇治疗的成年哮喘患者的 COVID-19 风险和结果：全国真实世界证据

背景

在严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 大流行期间管理严重哮喘具有挑战性，特别是由于对使用全身性皮质类固醇和生物制剂的安全性问题。

目标

我们试图确定哮喘患者中生物制剂或全身性皮质类固醇的使用与 SARS-CoV-2 和冠状病毒病 2019 (COVID-19) 结果的 PCR 阳性之间的关联。

方法

我们使用以色列最大的医疗保健提供者 Clalit Health Services 的计算机化数据库，确定了 2020 年 3 月 1 日至 2020 年 12 月 7 日期间接受 SARS-CoV-2 PCR 检测的所有哮喘成年患者。用于评估生物制剂使用和类固醇治疗与 COVID-19 严重程度和 90 天死亡率之间的关联。

结果

总体而言，80,602 名接受测试的哮喘患者中有 8,242 名的 SARS-CoV-2 PCR 检测结果呈阳性。生物制剂和全身性皮质类固醇均与 SARS-CoV-2 感染风险增加无关。多变量分析显示，生物制剂与中至重度 COVID-19 风险显着增加无关，也与中至重度 COVID-19 或 90 天内全因死亡率的复合终点无关。慢性全身性皮质类固醇使用与所有测试结果的风险显着增加有关。最近（在过去 120 天内）全身性皮质类固醇的使用，但不是以前的使用，与中度至重度 COVID-19 以及中度至重度 COVID-19 或全因死亡率的复合风险增加显着相关。

结论

批准用于哮喘和全身性皮质类固醇的生物制剂与 SARS-CoV-2 感染风险的增加无关。相比之下，全身性皮质类固醇是 COVID-19 最严重严重程度和全因死亡率的独立危险因素。我们的研究结果强调了感染 SARS-CoV-2 的哮喘患者近期或当前暴露于全身皮质类固醇的风险。