免疫抑制药物与COVID-19住院和死亡之间的关联:一个回顾性队列研究
Samantha J Sechrist1,2, Emily Tang1, Benjamin F Arnold1,3
1Francis I Proctor Foundation for Research in Ophthalmology, San Francisco, California, USA.
BMJ open
|December 26, 2024
概括
系统性皮质类固醇显著增加COVID-19住院和死亡风险,特别是在未接种疫苗的人群中. 与DMARD和TNF等免疫抑制剂的同时使用进一步增加了这些风险.
科学领域:
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 免疫功能低下的人面临严重SARS-CoV-2 (COVID-19) 感染的风险更高.
- 有限的数据存在于系统性皮质类固醇剂量和同时使用免疫抑制剂对COVID-19结果的影响.
研究的目的:
- 评估皮质类固醇剂量/持续时间和同时使用免疫抑制剂与COVID-19住院治疗和死亡率之间的关联.
- 在COVID-19疫苗接种可用性的背景下评估这些风险.
主要方法:
- 使用非识别保险索赔数据库的回顾性队列研究 (2020年7月 - 2022年6月).
- 分析包括超过1000万符合条件的患者,风险期从2021年7月开始.
- 考克斯回归和归因风险分析评估了皮质类固醇暴露,其他免疫抑制剂 (DMARD,TNFis) 和疫苗接种状态.
主要成果:
- 皮质类固醇与COVID-19住院 (HR:5.40) 和死亡 (HR:5.90) 的风险显著增加有关.
- 接受皮质类固醇的未接种疫苗的人患病率增加了3倍,死亡率增加了14.5倍.
- 与DMARDs (HR: 1.55) 或TNFis (HR: 1.60) 同时使用皮质类固醇进一步放大了住院的风险.
结论:
- 系统性皮质类固醇与COVID-19住院和死亡的风险大幅增加有关.
- 这些风险在未接种疫苗的人群中尤为明显.
- 皮质类固醇与DMARD或TNF的联合使用加剧了COVID-19的不良结果.
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