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Coronavirus disease 2019, immune-mediated inflammatory diseases and immunosuppressive therapies – A Danish population-based cohort study

  • Attauabi, Mohamed1, 2, 3
  • Seidelin, Jakob Benedict3
  • Felding, Oluf Krautwald1, 2
  • Wewer, Mads Damsgaard1, 2
  • Vinther Arp, Laura Kirstine1, 2
  • Sarikaya, Melek Zahra1, 2
  • Egeberg, Alexander4
  • Vladimirova, Nora5
  • Bendtsen, Flemming1, 2
  • Burisch, Johan1, 2
  • 1 Gastrounit, Medical Section, Hvidovre University Hospital, Hvidovre, Denmark
  • 2 Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Denmark
  • 3 Department of Gastroenterology and Hepatology, Herlev Hospital, University of Copenhagen, Denmark
  • 4 Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
  • 5 Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Center of Head and Orthopedics, Rigshospitalet, Glostrup, Denmark
Published Article
Journal of Autoimmunity
Publication Date
Feb 12, 2021
DOI: 10.1016/j.jaut.2021.102613
PMID: 33592545
PMCID: PMC7879155
PubMed Central


Background Limited data exist regarding the disease course of coronavirus disease 2019 (COVID-19) and its relationship with immunosuppressants among patients with immune-mediated inflammatory diseases (IMIDs). Therefore, this study aims to investigate the association between COVID-19, frequent rheumatological, dermatological, gastrointestinal, and neurological IMIDs and immunosuppressants. Methods We conducted a Danish population-based cohort study including all residents living within Capital Region of Denmark and Region Zealand from January 28th, 2020 until September 15th, 2020 with the only eligibility criterion being a test for SARS-CoV-2 via reverse transcription–polymerase chain-reaction. Main outcomes included development of COVID-19, COVID-19-related hospitalization and mortality. Results COVID-19 was less common among patients with IMIDs than the background population (n = 328/20,513 (1.60%) and n = 10,792/583,788(1.85%), p  < 0.01, respectively). However, those with IMIDs had a significantly higher risk of COVID-19-related hospitalization (31.1% and 18.6%, p  < 0.01, respectively) and mortality (9.8% and 4.3%, p  < 0.01, respectively), which were associated with patients older than 65 years, and presence of comorbidities. Furthermore, systemic steroids were independently associated with a severe course of COVID-19 (Odds ratio (OR) = 3.56 (95%CI 1.83–7.10), p  < 0.01), while biologic therapies were associated with a reduced risk hereof (OR = 0.47 (95%CI 0.22–0.95), p  = 0.04). Patients suspending immunosuppressants due to COVID-19 had an increased risk of subsequent hospitalization (OR = 3.59 (95%CI 1.31–10.78), p  = 0.02). Conclusion This study found a lower occurrence, but a more severe disease course, of COVID-19 among patients with IMIDs, which was associated with the use of systemic steroids for IMIDs and suspension of other immunosuppressants. This study emphasizes the importance of weighing risks before suspending immunosuppressants during COVID-19.

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