Abstract
Purpose :
Systemic corticosteroid (SC) exposure was found to be associated with greater risk of COVID-19 infection and severe illness in patients with noninfectious uveitis (NIU) in the era prior to widespread COVID-vaccination. Vaccination lowers the risk of severe COVID-19 outcomes, but the impact of immunosuppression in vaccinated patients is unclear. The aim of this study was to determine if SCs and other immunosuppressants are associated with an increased risk of COVID-19 hospitalization in NIU patients in a post-vaccination era.
Methods :
We performed a retrospective cohort study from 7/1/2021 to 6/30/2022 using a US claims database. Those with ≥1 NIU diagnosis from January 1, 2017 were included. Incidence rates (IR) of COVID-19 hospitalization were calculated by immunosuppressant exposure and vaccination status. Adjusted hazard ratios (HR) for COVID-19 hospitalization were estimated for each variable using Cox proportional hazards models with time-updated dichotomous indicators for immunosuppressant exposure. Models adjusted for age, sex, race/ethnicity, region, smoking status, comorbidities, NIU disease severity, dominant COVID-19 variant (Delta or Omicron), past COVID-19 infection, and COVID-19 vaccination status.
Results :
62,209 NIU patients, of whom 12,895 (20.7%) were exposed to immunosuppressants during the risk period, were included. The IR of COVID-19 hospitalization was 68.3 cases per 1000 person-years (PY) in the group exposed to SC versus 14.3 cases per 1000 PY in the unexposed group. The IR of hospitalization in those exposed to SC who did not have record of COVID-19 vaccination was 104.9 cases per 1000 PY versus 19.4 cases per 1000 PY in those exposed to SC with ≥1 vaccination record. In adjusted models, SC exposure was associated with increased risk of COVID-19 hospitalization (HR, 3.34; 95% confidence interval, 2.61-4.26; P < 0.0001). All other immunosuppressants were not significantly associated with hospitalization.
Conclusions :
SC exposure continues to be associated with greater risk of COVID-19 hospitalization in NIU patients in an era of widespread COVID vaccination. Those exposed to SCs who are not vaccinated have a greater risk of severe outcomes. Limiting exposure to SCs and use of alternative therapies may be prudent in patients with NIU. COVID vaccination should be strongly encouraged in patients taking immunosuppressive therapies.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.